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CGRS <br /> Vc O-UTIONS OQU% R6C <br /> GENERAL CONTRACTOR STATEMENT <br /> Effective 05/26/15,the State Water Resources Control Board requires that the signed general <br /> contractor's statement be received from all genera[contractors prior to formal notification of final <br /> ELO testing (NO EXCEPTIONS). <br /> By signing below,the general contractor acknowledges that: <br /> "No further ground penetrating work,Including beautification requirements,atop or immediately <br /> adjacent to,the UST system are needed or will be performed after ELD testing is performed." <br /> General Contractor Information <br /> Company Name/CA Contractor License#: Able Maintenance <br /> Contact: Ryan Brownlee <br /> Address: 3224 Regional Parkway, Santa Rosa, CA 95403 <br /> Telephone/Emall: 707-569-4791/ryan@ablemaintenance.com <br /> Site Information <br /> Site Name: Safeway <br /> Address: 2802 Country Club Blvd,Stockton, CA 95204 <br /> Telephone: unknown <br /> County: San Joaquin <br /> CUPA Email: ust@sjgov.org <br /> Testing Company Information <br /> Name: CGRS,Inc. <br /> Technician Assigned/License M Richard Thomas/#06-1672 <br /> Sia~nature <br /> General Contractor's Signature: r— <br /> Name(.print): +�^ I(J�1&G <br /> Title: -1 ?► Date of Signature � <br /> : � <br /> U44 Dry Creek lid. Smmeft CA 9M 7916.991.1100 F 916.491.1111 www.ojaltax <br />