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Underground Storage Tank Removal SR0074318 <br /> UST Removal. 1825 E. Martin Luther King, Jr. Blvd., Stockton, CA 95205 <br /> 7. See `Sampling Protocol for Routine Tank Removals' and `Verification Analysis' on page <br /> 6 and 7 of the permit application for required analytical tests and number of samples to <br /> be taken and witnessed by EHD. <br /> 8. A copy of the Fire Department permit must be submitted at the time of removal. <br /> 9. In addition, the following information must be submitted within 30 days after the UST <br /> removal date: <br /> a. Analytical results: only results that come directly from a third party California certified <br /> laboratory with affixed chain of custody will be accepted by EHD <br /> b. UST Tracking Record Sheet and/or Tank and Piping Hazardous Waste Manifest <br /> c. Tank Closure Certification Form (DTSC Form 1249) <br /> d. Hazardous Waste Manifest for rinsate and residual product <br /> e. Backfill Excavation Certificate <br /> 10. Permit expires 180 days from the date of approval. If an extension to the expiration date <br /> is required, a written request must be submitted to this office prior to the expiration date. <br /> If you have any further questions, please contact me at (209) 468-3440. <br /> Thank you, <br /> Stacy , REHS <br /> Senior Registered Environmental Health Specialist <br /> Cc: CCJ&S LLC, 2423 W. March Ln. Suite 202, Stockton, CA 95207 <br /> 2 <br />