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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pros. City of Lodl <br /> Patricia E. Vannucal, Sec'y. 1601 � � Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Anthonette Van Spronsen City of Escalon <br /> Earl Pimentel Stockton, California 95201 City of Manteca <br /> Fern Bugbee 209466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> 'William J. Wade Jogl Khanna, M.D., M.P.H., Dist ct Health Offloer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> UNDERGROUND STORAGE TANK PROGRAM <br /> r 'RE: AR`E`- <br /> MOVAL POLICY* <br /> The following information shall be submitted in duplicate on all Permanent Closure/ <br /> Tank Removal Pians: <br /> 1 . Facility address and telephone number of owner (or operator if different than <br /> owner). <br /> 2. Provide a parcel plot plan showing tank(s) to be removed and tank(s) distance <br /> from all premise septic tanks, buildings, and property lines, and all wells <br /> within 500 ft. <br /> 3. Provide the name of the contractor, includi g contractor's classification, <br /> license number, and certificate of workers ompensation insurance. <br /> 4. Identify the tank(s) size and product(s) currently and/or previously stored in <br /> each tank. <br /> 5. Provide the name of laboratory that will co lett soil samples and, a "Release of <br /> Information Authorization" form signed by tie facility owner/operator. <br /> qtmrdble"apo <br /> 8. Method of dis osal or reus <br /> a. If the and ground s rage tank or any art of an underground storage tank <br /> is destined or a ecific reuse, ident fy the future underground storage <br /> tank owner/o r or, location of use, aid nature of use. <br /> b. If an underg nd storage tank or any part of an underground storage tank <br /> is destined or use as scrap material identify this reuse to the <br /> San Joaqu' .Loca Health District. <br /> c. If the dergroun storage tank or any art of the underground storage tank <br /> is to disposed o , identify and document the method of disposal . <br /> On submission of the above information the cion re plan will be approved, approved with <br /> changes, or disapproved. <br /> After approval of plan, contact with this office is required to schedule an inspection <br /> at least 24 hours prior to tank removal/soil sampling. <br /> * The above general policy shall apply to underground storage tanks which have no <br /> known unauthorized release or other unusual c rcumstances. All other closures <br /> may require additional site specific activities prior to approval of the closure <br /> plan. <br /> 3/86 UGT 10 <br />