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9255517858 Line 1 08:40:06 06--15-2015 5110 <br />0 0 <br />ENVIRONMENTAL HEALTH DEPARTMENT' <br />IV <br />SAN JOAQUIN COUNTY <br />600 East Main Street, Stockton, California 95202 JUN 15 2015 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />APPLICATION FOR UNDERGROUND STORAGE TANK RETROFIT OR PIPING REPAIR -PERMIT <br />THIS PERMIT EXPIRES 180 DAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE BELOW: <br />TANK RETROFIT El PIPING REPAIRIRETROFIT ❑ UDC REPAIRIRETROFIT 14 COLD STARTIEVR UPGRADE <br />F <br />EPA Site # <br />Project Contact & Telephone # <br />Liddy McKenzie (925.551.7555) <br />A <br />C <br />Facility NameARCO 9829841 <br />Phone# <br />I <br />L <br />Address 7611 S AJ RPORT WAY <br />ICross <br />Street <br />Y <br />I Owner/Operator BP West Coast Products LLC <br />Phone# <br />o <br />contractor NameGettler-Ryan Inc <br />Phone # (925) 551-7555 <br />T <br />Contractor Address 6805 SIERRA CT, SUITE G, DUBLIN, CAS4568 CA Lic # <br />220793 Class+aa�aasi,ce o�o.x+zMic <br />A <br />insurer State Compensation Ins Fund <br />Work CDmp # 9051229-3 <br />T <br />ICC Technician's Name CHRIS SAN NICOLAS <br />Expiration Date 03/17/2017 <br />R <br />ICC I' <br />nstaliels Name <br />Expiration Date <br />Tank system work area Tank Size <br />O.e. 87 piping Sump, 91 lank detector, Utx: 112, e1c.l <br />Chemicals Stored Currently <br />y <br />Date UST <br />Installed <br />T <br />A <br />N <br />K <br />P <br />❑ Approved Approved with conditions <br />Disapproved <br />L(See <br />A achment With Conditions) <br />A <br />N <br />Plan Reviewers Name' ��1 <br />gate <br />APPLICANT <br />MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF SAN <br />JOAQUIN COUNTY, ENVIRONMENTAL HEALTH PARTMENT. OWNER OR LICENSED AGENTS SIGNATURE <br />CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN <br />THE PERFORMANCE OF THE WORK FAR W THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON <br />IN SUCH A MANNER AS TO BECOME SUBJECT <br />TO WORKER'S COMPENSATION LAWS OF FO " CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY <br />THAT <br />IN THE PERFORMANCE OF THE H THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS <br />OF CALIFORNIA" <br />Applicant's Signature rme AGENT FOR OWNER <br />Date06/12/2015 <br />v BILLING INFORMATION: <br />Indicate the responsible party to be billed for additional EHD staff time expended beyond permit payment coverage per tank. If <br />the party designated below is different than the permit applicant, e.g. property owner, the party must acknowledge this <br />responsibility for the billing by signature and date below. <br />NAME Liddy McKenzie . TITLE PrOiect Manaqer PHONE #925.551.7555 <br />ADDRESS <br />EH23D038 (revised 02120109) <br />1 <br />