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REMOVAL 2005
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231760
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REMOVAL 2005
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Last modified
8/23/2019 9:50:05 AM
Creation date
8/22/2019 2:30:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
2005
RECORD_ID
PR0231760
PE
2351
FACILITY_ID
FA0003831
FACILITY_NAME
WATERLOO FOODMART
STREET_NUMBER
4315
Direction
E
STREET_NAME
WATERLOO
STREET_TYPE
RD
City
STOCKTON
Zip
95215-2305
APN
08710034
CURRENT_STATUS
01
SITE_LOCATION
4315 E WATERLOO RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Unit Supervisors <br /> Donna K.Heran,R.E.H.S. man,R.E.H.S. <br /> Carl Bor <br /> Director 304 East Weber Avenue, Third Floor g <br /> Al Olsen,R.E.H.S. Stockton, California 95202-2708 Mike Huggins, S.,R.D.I. <br /> Douglas W.Wilson, <br /> R.E.H.S. <br /> • �q, �- �w Program Manager Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> <<FOR Laurie A.Cotulla,R.E.H.S. p <br /> Program Manager Fax: (209) 464-0138 Robert McClellon,R.E.H.S. <br /> Mark Barcellos,R.E.H.S. <br /> March 17, 2005 <br /> Attn: Tom Piskor <br /> 3140 Gold Camp Dr. #120 <br /> Rancho Cordova, CA 95670 <br /> Fax: (916) 631-1317 <br /> RE: 4315 Waterloo Road, Stockton—Waterloo Shell—SR0039540 <br /> The San Joaquin County Environmental Health Department(SJCEHD)has received the <br /> addendum request dated March 16, 2005 for underground storage tank removal permit <br /> (SR0039540) at the above referenced location. The addendum request has been approved <br /> with the following conditions: <br /> 1. The conditions in this approval do not supersede any conditions on the original <br /> approval. <br /> 2. In addition, the following documentation shall be submitted within 30 days of the <br /> t nk removal date: <br /> , WAnalytical results, mailed directly from laboratory to SJCEHD, including a chain t ,� <br /> of custody and quality assurance and quality control (QA& QC). <br /> (b) UST Tracking Record Sheet(s) and/or Tank Hazardous Waste Manifest(s). Q -�d <br /> (c) Tank Closure Certification Form. <br /> 1/(d) Hazardous Waste Manifests for piping, rinsate, residual fuel, or waste oil receipt. .�n C. <br /> v(e) Tank Certification from Marine Chemist. <br /> (f) Certificate of Destruction from Vasco Road Landfill. .7/(5-5Z3 �l y3o <br /> If you have any questions please contact Steven C. Shih at (209) 468-9850. <br /> Thank you, <br /> r <br /> Steven C. Shih, Senior R.E.H.S. <br /> San Joaquin County <br /> Environmental Health Department <br /> Page 1 of 1 <br />
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