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9,1.5551788$ Line 1 12:42:36 02-06-2015 4/12 <br /> R F-CHVEE." <br /> ENVIRONMENTAL HEALTH DEPARTMEN.TB 0 6 2015 <br /> SAN JOAQUIN COUNTY <br /> 600 East Main Street, Stockton, California 95202 ENVIRONMENTAL <br /> t.lrry,TfJ r1rOn nT! <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 /> 1Z TANK RETROFIT ❑ PIPING REPAIR/RETROFIT ❑ UDC REPAIR/RETROFIT ❑ COLD START/EVR UPGRADE <br /> F EPA Site# Project Contact&Telephone# Liddy McKenzie (925,551.7555) <br /> A <br /> C Facility NameARCO 6080 Phone# <br /> � Address 85 E LOUISE AVE, LATHROP, CA 95330 <br /> 1 Cross Street HARLAN <br /> T <br /> Y Owner/Operator BP West Coast Products LLC Phone# <br /> o Contractor NameGettler-Ryan Inc Phone# <br /> (925) 551-7555 <br /> N <br /> r Contractor Address 6805 SIERRA CT,SUITE G,DUBLIN,CA9456B CA Lic# 220793 CIa5Sn,6Wd.w <br /> ,cIo,W.C4�04o. c <br /> A Insurer State Compensation Ins Fund work comp# 9051229-3 <br /> cICC Technician's Name <br /> T Wesley Morrison Expiration Date 03/17/2017 <br /> R ICC Installer's Name Expiration Date <br /> Tank system work area Tank Size Chemicals Stored Currently Date UST <br /> (i.e.87 piping sump,91 leak detector,UDC 1/2,etc.) Installed <br /> T <br /> A <br /> N <br /> K <br /> P ❑ Appro ed &echment <br /> roved with conditions Disappr ved <br /> L G With Conditions) <br /> A <br /> N Plan Reviewers Name Date <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN CO TY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN <br /> JOAQUIN COUNTY, ENVIRONMENTAL HE9 TH DEPARTMENT.OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN <br /> THE PERFORMANCE OF THE WORK FO HICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT <br /> TO WORKER'S COMPENSATION LAW F CALIFORNIA" CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY <br /> THAT IN THE PERFORMANCE OF T WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS <br /> OF CALIFORNIA." <br /> Applicant's Signature Tits. AGENT FOR OWNER Date02/06/2015 <br /> 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 /> NAMELiddy McKenzie TITLE Project Manaqer PHONE#925.551.7555 <br /> ADDREss6805 SIERRA CT SUITE G DUBLIN 94568 <br /> SIGNATURE DATE <br /> EH230038(revised 02/20/09) <br /> 1 <br /> Received Time Feb, 6. 2015 11 : 31AM No- 8055 <br />