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19255517888 Main Fax GETTLER RYAN INC 11:43:07 a.m. 12-20-2006 4/11 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE,en FLOOR STOCKTON,CA 96202 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_PIPING REPAIRIRETROFIT_UNDER DISPENSER CONTAINMENT REI�r IRJRETROFIT ------------------------------------------------------ --------------------------------------------------------------+ EPA SITE N ; PROJECT CONTACT & TELEPHONE # LIODYMCKENZIE M 551.7355 ' ' --------------------------------------- -------------------------------------------------------------------------------------- :; FACILITY NAME ARCO ; PHONE N 925 561.7566 . A --r----------------------------' -------- C ; ADDRESS 65 E LOUISE AVE -------� I --------------------------------------------- ----------------------------------------------------------------------- L I CROSS STREET 1.5 I +------------------------------------------------------------------------------------;-PHONE M-------------------------------------- T ; OWNER/OPERATOR Y ; ARCO ; ----------------------------- ---------------------------------------------------------+----------------------------------- c ; CONTRACTOR NAME Gettler Ryan Inc. ; PHONE M W25 551-7565 O +-------------------------------------------------- ------------------------------ ------------------------------; N ; CONTRACTOR ADDRESS 6747 Sierra Court,Suite J Dublin 1 CA LIC # 220799 I CLASS a,b,c-10,haz,e57,c61,d40 - -----------------------------------------------------------------------------------------------------------t ; WORK COMP.# 42007 R ------ -SURER State Comp Fund ---------------------+- ------------------------------ C 1 OTHER INFORMATION T +------------------------------------------------------------------------------------+----------------------------------- 0 l ; PHONE #925 551.7555 ; R +------------------------------------------------------------------------------------+----------------------------------------I PHONE 6 ---------------- -- �"11 TANK IDI# TANK SIZE ; CHEMICALS STORED CURRENTLY/PREVIOUSLY ; DATE UST INSTALLED 39- 1 T ; 39- A 39- E ; N ; 39- K 39- 39- P L PROVE: APPROVED WITH CONDITION(S) DISAPPROVED A 1 ( E ATTACHMENT WITH CONDITIONS) N ; PLAN REVIEWERS NAME DATE 2,1 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 E WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." APPLICANT'S SIGNATURE: , TITLE Permit Expeditor CA,.y2b.� --- ------— ------ - -----------------------` ------ -—--. ..---- ---------------------- - ------ 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 than the permit applicant, e.g. property owner, the party must acknowledge this responsibility for the billing by signature and date below. 6747 Sierra Court,Suite J Name LIDDY MCKENZIE A dress Dublin 94568 Phone # 925 551-7555 Signature EH230038 (revised 1/31/02) 1