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SANAOAQUINEnvirinmental Health Department <br />COUNTY <br />6. A copy of the submitted "Health and Safety Plan" must be on the jobsite for review. <br />7. See `Sampling Protocol for Routine Tank Removals' and `Verification Analysis' on page 6 and 7 <br />of the permit application for required analytical tests and number of samples to be taken and <br />witnessed by EHD. <br />8. Submit verification of the fire permit from the Waterloo Morada Fire District at the removal <br />inspection. <br />9. In addition, the following information must be submitted within 30 days after the UST removal <br />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 is <br />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) 468-0343. <br />Thank you, <br />Elianna Florido, <br />ICC Certified UST Inspector <br />Cc: California Highway Patrol #265, 3330 N. Ad Art Road, Stockton, CA 95215 <br />2 of 2 <br />