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• San Joaquin County • Environmental Health Department 304 E Weber, 3'd Floor Stockton, CA 95202 Application for Underground Tank Retrofit,or piping repair permit This permit expires 90 days from the approval date. Do not write in any shaded areas. Indicate permit type below: _---------—___ _—Tank Retrofit__-x-Piping Repair I Retrofit_____UrL r Dispenser Containment R�air/Permit EPA SITE# Project Contact&Telephone# Lori Freshour (916)858-1090 FACILITY NAME ARCO 6335 Phone#(209)948.2438 ADDRESS 4855 St Hwy 99, Stockton CROSS STREET Arch OWNER/OPERATOR BP West Coast Products,LLC Phone#(209)649-3335 ---------------------------------------------------------------- ---- --------- — CONTRACTOR NAME Tait Environmental Systems Phone# CONTRACTOR ADDRESS 3283 Luyung Dr I CA LIC#588098 Class C10 B A ASB HAZ H1 C INSURER Brakke Schatnitz Work Comp#092000018502 OTHER INFORMATION Phone# (916)858-1090 Fax# (916)858-1011 Tank ID# Tank Size Chemical Stored Currently/Previously Date UST Installed -- -------------------------------------------------------------- ------------ W 87 -------- 20000 Gasoline 39- 89 12000 Gasoline 39- 91 10000 Gasoline 39- 39- 39- 39- Approved -----..-------------------- pp Approved with Condition(s) _Disapproved Plan Reviewer's Name �A4U 'l /F7—0 APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, ENVIRONMENTAL HEALTH DEPARTMENT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSEUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." —-- APPLICANTsSIGNATURE �1 TITLE ComplianceMar DATE 11/4/03 Billing Information: Indicate the responsible party to be billed for additional EHD staff time expended beyond permit payment coverage per tank. If the party designated below is different that the permit applicant, e.g. property owner, the party must acknowledge this responsibility for the billing by signature and date below. Name BP West Coast Product LLC Address-4 Center Pointe Dr, La Palma CA 90623 Phone# (209)649-3335 Signature�� J b'm s 4- EH230038 f• fA( Neta, PCO kC ctfi 201. t4uN 5t l Ui( -tv a,rratje-. CWS I nSQe(+av 1 (revised 1/31/02) � I'm &V DP Z. Thz p)lrW of vvp fie, 4'ynus-isly D4 olelivevy -Flow M, q50/o 0� fAn1k Capft(Ii 3 MIDIa o�_ Lf 8- hmanr rwhbc, -dor all ht pe ch'c . 5(xWWZ a-v) i n,DPf C fvy-v b4--A-I-o q