Laserfiche WebLink
ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> APPLICATION FOR UNDERGROUND STORAGE TANK INSTALLATION PERMIT <br /> THE APPLICATION FOR INSTALLATION OF UNDERGROUND STORAGE TANKS IS ONLY VALID FOR THE CALENDAR YEAR IN WHICH IT HAS BEEN <br /> ISSUED. A PERMIT MAY BE EXTENDED INTO THE NEXT CALENDAR YEAR IF A LETTER IS SENT TO EHD REQUESTING THIS EXTENSION THIRTY DAYS <br /> PRIOR TO THE END OF THE CALENDAR YEAR. A ONE TIME,ONE YEAR EXTENSION MAY BE GRANTED BY EHD UPON RECEIPT OF THIS LETTER. <br /> PROJECT CONTACT: CONTACT PHONE# <br /> GETTLER-RYAN INC (Liddy McKenzie) 925.551.7555 <br /> FACILITY NAME: FACILITY PHONE# <br /> BP ARCO #6080 209.983.9144 <br /> FACILITY ADDRESS: CROSS STREET: <br /> 85 E. LOUISE AVE INTERSTATE 5 <br /> OWNER/OPERATOR: PHONE: <br /> JAMAL KABARITI 209.98.9144 <br /> CONTRACTOR NAME: PHONE: <br /> GETTLER-RYAN INC 925.551.7555 <br /> CONTRACTOR ADDRESS: CA LICENSE# <br /> 6747 SIERRA CT, #J, DUBLIN, CA 94568 220793 <br /> HAZARDOUS WASTE CERTIFICATE: WORKERS COMP# <br /> YES NO DTJUB7827P41510 <br /> FIRE DISTRICT: PERMIT# <br /> BOARD OF EQUALIZATION# <br /> TANK ID# TANK SIZE CHEMICAL STORED PROPOSED INSTALL DATE <br /> 51 qCf 20,000 REGULAR UNLEADED 12/2010 <br /> ( 12,000 PREMIUM UNLEADED 12/2010 <br /> 10,000 DIESEL 12/2010 <br /> ❑APPROVED YAPPROVED WITH CONDITIONS ❑ DISAPPROVED <br /> (see attachments) <br /> PLAN REVIEWER'S NAME DATE <br /> APPLICANT MUST PERFORM ALL WORK IN CORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, <br /> RULES AND SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT. OWNER OR LICENSED AGENT'S <br /> SIGNATURE CERTIFIES THE FOLLOWING" I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS <br /> PERMIT IS ISSUED., I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO <br /> WORKER'S COMPENSATION LAWS OF CALIFORNIA." C JITRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE <br /> CERTIFIES THE FOLLOWING "I CERTIFY THAT IN THE'PF�FOR ANCE OF THE WORK FOR WHICH THIS PERMIT IS <br /> ISSUED, I SHALL EMPLOY PERSONS SU ECT T WQRE-R MPENSATION LAWS OF CALIFORNIA." <br /> Applicant's Signature <br /> Title PROJECT MANAGER Date 11/09/2010 <br /> Indicate the responsible party to be billed for additional EHD staff time expended beyond the 8-hour minimum installation <br /> payment.The party must acknowledge this responsibility for the additional billing by signature and date below. <br /> Name GETTLER-RYAN INC. Date 11/09/2010 <br /> Mailing Address 6747 SIEPAA CT, #J, OUALIN, CA 94568 <br /> Signature Daytime Phone 925.551.7555 <br /> Revised 07/22/10 3 <br />