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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pro&. City of Lodi . <br /> Patricie E. Vannuxl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County E: <br /> Anthonette Van Spronsen City of Eacalon <br /> Earl Pimentel Stockton, California 915201 City of Manteca <br /> Fern Bugbee 209/466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Most, M.D. City of Tracy <br /> William J. Wade Joel Khanna. M.D., M.P.H., Dletrici Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> t <br /> UNDERGROUND STORAGE TANK PROGRAM <br /> *REMOVAL <br /> �RE: POLICY* <br /> The following information shall be submitted in duplicate on all Permanent Closure/ <br /> Tank Removal Plans: <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) t be removed and tank(s) distance <br /> from all premise septic tanks, buildings, and property lines, and all wells <br /> within 500 ft. f <br /> 3. Provide the name of the contractor, includin contractor's classification, <br /> license number, and certificate of worker�tcimpensation insurance. <br /> 4. Identify the tank(s) size and product(s) cur eptly and/or previously stored in <br /> each tank. <br /> 5. Provide the name of laboratory that will cal ect soil samples and a "Release of <br /> Information Authorization" form signed by the facility owner/operator. <br /> • aPvrst�-p�°ec�`G�e- <br /> 8. Method oX al or reus - <br /> a. I�f tround s rage tank or any p rt of an underground storage tank <br /> is dor a ecific reuse, identi y the future underground storage <br /> tank r or, location of use, an nature of use. <br /> b. If annd storage tank or any pa t of an underground storage tank <br /> is dor use as scrap material , identify this reuse to the <br /> San oca Health District. <br /> c. If thgroun storage tank or any p rt of the underground storage tank <br /> is toposed o identify and document the method of disposal . <br /> On submission of the above information the closure 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 sam ling, <br /> * The above general policy shall apply to underground storage tanks which have no <br /> known unauthorized release or other unusual circumstances. All other closures <br /> may require additional site specific activitie prior to approval of the closure <br /> plan. <br /> 3/86 UGT 10 <br />