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SAN J O A Q U I N Environmental Health Department <br /> COUNTY <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 <br /> certified 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 <br /> date is required , a written request must be submitted to this office prior to the expiration <br /> date . <br /> If you have any further questions , please contact me at (209 ) 468 - 0216 . <br /> TThayou , <br /> Sheit Woldearegay , EHS <br /> Environmental Health Specialist <br /> cc: Pilot Travel Center LLC- Joey Cupp, 5508 Lonas Rd, Knoxville <br /> joey. cupp@pilottracelcenters. com <br /> 2of2 <br /> i <br /> I <br />