Download Soil Aeration Supplemental Application Form

San Joaquin Valley Air Pollution Control District
Supplemental Application Form
Uncontrolled Limited Soil Aeration
This form must be accompanied by a completed Authority to Construct/Permit to Operate Application form
PERMIT TO BE ISSUED TO:
MAILING ADDRESS:
LOCATION WHERE THE SOIL(S) WILL BE AERATED:
PROCESS DESCRIPTION
Soil Analysis Details
Analyte
Average Concentration1
TPH-gasoline
____________ ppmw
TPH-diesel
____________ ppmw
Benzene
____________ ppmw
Toluene
____________ ppmw
Ethylbenzene
____________ ppmw
Xylene
____________ ppmw
Perchloroethylene
____________ ppmw
Other: ____________
____________ ppmw
Test Method2
Notes:
1
Total hydrocarbon concentration must be less than 5,000 ppmw to receive District authorization for an
uncontrolled soil aeration project.
2
Please attach a copy of relevant test results.
PROJECT DESCRIPTION
Quantity of soil to be aerated: _________________ yd3, or _________________ tons
Start date of soil aeration project:
Expected length of soil aeration project:
Project Details
Straight-line distance and direction to nearest residence3:
A Health Risk Assessment is required if there are any residences within 1000’ of the aeration site.
3
FOR DISTRICT USE ONLY
Date:
FID:
Project:
Public Notice: [ ] Yes [ ] No
Comments:
Northern Regional Office * 4800 Enterprise Way * Modesto, California 95356-8718 * (209) 557-6400 * FAX (209) 557-6475
Central Regional Office * 1990 East Gettysburg Avenue * Fresno, California 93726-0244 * (559) 230-5900 * FAX (559) 230-6061
Southern Regional Office * 34946 Flyover Court * Bakersfield, California 93308 * (661) 392-5500 * FAX (661) 392-5585
Revised: January 20, 2009