Laserfiche WebLink
07/30/2007 MON 12: 15 FAX 2094683433 SJC EHD 14001 <br /> ********************* <br /> *** FAX TX REPORT *** <br /> ********************* <br /> TRANSMISSION OK <br /> JOB NO. 0350 <br /> DESTINATION ADDRESS 919255517888 <br /> PSWD/SUBADDRESS <br /> DESTINATION ID <br /> ST. TIME 07/30 12: 13 <br /> USAGE T 01' 34 <br /> PGS. 5 <br /> RESULT OK <br /> 19255517888 Main Fax GETTLER RYAN INC 03:30:34 p.m. 06-26-2007 3/10 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SERVICE REQUEST <br /> Type of Business or Property FACILITY ID# SERVICE REQUEST# <br /> SERVICE STATION <br /> OWNER/OPERATOR <br /> CHECK if BILLING ADDRESS <br /> BP West Coast Products LLC <br /> FACILITY NAME ARCO 6080 <br /> SITE ADDRESS 85 E LOUISE AVE LATHROP 95330 <br /> Street N mbar Dlre 1 Street a city Y <br /> il)C000 <br /> HOME or MAILING ADDRESS (If Different from Site Address) 6747 6747 Sierra Court,Suite J <br /> Street Number <br /> Street a <br /> CITY STATE ZIP <br /> Dublin CA 94568 <br /> PHONE#1 Exr. APN# LAND USE APPLICATION# <br /> ( 925 ) 551.7555 <br /> PHONE#2 Exr. BOS DISTRICT LOCATION CODE <br /> ( ) <br /> CONTRACTOR/SERVICE REQUESTOR <br /> REQUESTOR LIDDY MCKENZIE CHECK if BILLING ADDRESS <br /> BUSINESS NAMEPHONE# EXT.Ryan Inc. 925 551-7555 <br /> HOME Or MAILING ADDRESS FAX# <br /> 6747 6747 Sierra Court,Suite J ( 925 ) 551-7888 <br /> CITY Dublin STATE CA ZIP 94568 <br /> BILLING ACKNOWLEDGEMENT: I, the undersigned property or business owner, operator or authorized agent of same, <br /> acknowledge that all site and/or project specific ENVIRONMENTAL HEALTH DEPARTMENT hourly charges associated with this project <br /> or activity will be billed to me or my business as identified on this form. <br /> I also certify that I have prepared this application a t the work to be performed will be done in accordance with all SAN JOAQUIN <br /> COUNTY Ordinance Codes,Standards,STATE and E AL laws. <br /> APPLICANT'S SIGNATURE: DATE: Y' ��� ")6-1 <br /> PROPERTY/BUSINESS OWNER 13 OPERAT /M AGER ❑ OTHER AUTHORIZED AGENT W Agent for Owner <br /> If APPLICANT is not the BILLING PARTY,proof of authorization to sign is required Title <br /> AUTHORIZATION TO RELEASE INFORMATION: When applicable, I,the owner or operator of the property located at the <br /> above site address, hereby authorize the release of any and all results, geotechnical data and/or environmental/site assessment <br /> information t0 the SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT as soon as it is available and at the same time it is <br /> provided to me or my representative. <br /> TYPE OF SERVICE REQUESTED: UST RETROFIT <br /> COMMENTS: <br /> REPLACE A POSITION SENSITIVE SENSOR(P/N 794380-323) V , n/_/� �� `lUN 2 6 z <br /> SAN <br />