Laserfiche WebLink
-17 <br /> I r SERVING <br /> 0.:1AF.0 OF TR'JSTFES S40dOAQUIN LOCAL HEALTH ;'DIST t ff��JJ <br /> i Sar,Joaquin County <br /> ^' "!ow,Pre,. 1601 East Hazelton Avenue City of Manteca <br /> Ead Wank(Vice PME, iCity of Escalon <br /> TommyJ,)Yce,Sec'+. Stockton, California 95205 <br /> City of Lodi <br /> James F.Culbertson DISTRICT HEAL OlI'CER City of Trac <br /> j&,n D.Mast.fl-D. JOGI KHANNA, M.D., M-P.H., City of Ripon <br /> Virginia Mail-lows <br /> Thomas Schubert,D.V.M. San Joaquin County <br /> Daphne Shaw n 2�� dQ?)k Z S I p�JrTy �,�' City of Stockton <br /> San Joaquin County <br /> Harvey WMAms,Ph.D. <br /> APPLICATION ICOR PERMIT TO CT.OSE <br /> UNDE,RCl:OUNjgX(T.­ X1NK� S'I`[�1?I C�1c __!-A-7-0.1 MATERIALS <br /> GE»4ERAL INSTRUCTIONS: <br /> iI v <br /> 1 Subndt all information in triplicates. USE CARS D <br /> lam' 1• Include a detailed site map showing tank1 local:ion A40 11e 6,1989 <br /> j <br /> pipingstreets and adjacent properties (north toward t <br /> top o1�the pagge) location of nearby septic tan}�,EORp N�M,E N A(.HEALTH <br /> leachfields, <br /> me) <br /> and underground public VII J O � EWCES <br /> (including water, sanitary sewer and storm sewer) . w <br /> I Ij <br /> G ?. Complete form "APPLICA'T'ION OR PERMIT E�OIt UNDII GROUND 'TANK 10AD <br /> CLOSURE," . �Q2 dS l a,& tM-Irp I /'_Ql(�1� G-� L!H II ��. <br /> Complete the "Authorization to Release Analytjcal Data" form. <br /> (_ 5. Submit the apr-opri,ate fees ..and complet-e. .Lhe 'Underground <br /> gQnk Program fee Workshiset". <br /> 51/1. Procedures should explain decontamination techniques if <br /> ap-licable, material(s) utilized for rinsate,Itransportation <br /> air /or storage of hazardous waste generated on site, and <br /> specify the responsible par.t:ykes) who will b6 disposing of } <br /> waste generated on site. <br /> V/7. Procedures should explain purging and/or' iner"Ing methc�. <br /> +I <br /> Describe in detail how soil and/or water; samples beneath thr- <br /> tank's invert will be obtained. Refer. to "Sallipl ing Protocol <br /> for Routine gAnk Removals" for sampling t.ritE:ba, i <br /> .mj 9. Con")Iete the San Joaquin Local Health District (SiLHD) <br /> "Undergrouml 'T'ank Disposition Tracking 150cordt' . The holder <br /> of the permit shall be r.c:sff-�onsible for i0suri.ng that: this form <br /> is completed and returned the WHY <br /> EJ 10. The maximum review time for Closure Plan's is 15 working days <br /> from the date & receipt`of the adequately completed Plan. <br /> I! <br /> 1� Advance i.n;pec=t,.ion notice of .fit; `least: 40 hour's is-required Qv <br /> he .facxu3.nr_ocal_ I �_ a11Z?i ric�E.:'i Ar_'r��r. .i.,► 'e advance <br /> As�.�ec-ion .tanaT- <br /> COiICI(`.l Uri ? r_:� Onai7aEA 23 040 <br /> 17.1{ — -- <br /> REVISED :12/88 1 <br /> . CC- <br /> f3 <br /> f3,.- 17r-rr'-CF-T7Wv <br /> ft f /f i <br /> 1 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-3400 468-3830 468-3420 ;? 468-3860 <br /> Air Pollution Community Services UiOratory: WIC <br /> 468-3470 468.3620 460-3460 " 468-3280 <br /> i <br /> AIDS Information 468-^820 <br />