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RECEIVED <br /> SANEnvironmental Health Department <br /> ENVIA <br /> � II--11 lrJ�UIL HEALTH <br /> DEPARTMIAT ILICATION FOR UNDERGROUND STORAGE TANK <br /> PRETROFIT OR PIPING REPAIR PERMIT <br /> THIS PERMIT EXPIRES 180 DAYS FROM THE�/APPROVAL DATE. INDICATE PERMIT TYPE BELOW: <br /> 171 TANK RETROFIT 11 �f PIPING REPAIR/RETROFIT UDC REPAIRIRETROFIT ❑ COLD START/EVR UPGRADE <br /> F EPA Site # Project Contact & Telephone # Robert Velasco (661 ) 250- 9300 <br /> � <br /> Facility Name BP / ARCO Site #7147 Phone # 661 -250-9300 <br /> I <br /> L Address 1206 East March Lane , Stockton CA 95210 <br /> 1 Cross street West Lane <br /> T <br /> Y Owner/operatorBP Products North America Inc . Phone # 661 - 250-9300 <br /> C Contractor Name CE Thomas Company Inc . Phone # 310-323-6730 <br /> 0 <br /> N Contractor Address 13701 Alma Avenue , Gardena CA 90249 CA Lic # 302015 Class A, B , C- 10 , C-61 , <br /> T <br /> A Insurer Insurance Company of the West Work Comp # WPL504465560 <br /> T I ICC Technician's Name Rigoberto Cruz Expiration Date 8/ 19/2022 <br /> R ICC Installer's Name Sergio Torres Expiration Date 9/22/2022 <br /> Tank system work area Tank Size Chemicals Stored Currently Date UST <br /> (i,e 87 piping sump, 91 leak detector, UDC 112, etc. ) Installed <br /> T Existing UST ' s & To Remain . <br /> A <br /> N <br /> K <br /> P ❑ Approved Approved with conditions ❑ Disapproved <br /> L (See Attachment With Conditions) <br /> A � I <br /> N Date 2 2 ii <br /> Plan Reviewers Name <br /> APPLICANT MUST PERFORM ALL WORK IN ACCO ANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF SAN <br /> JOAQUIN COUNTY, ENVIRONMENTAL HEALTH ARTMENT, OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING : "I CERTIFY THAT IN <br /> THE PERFORMANCE OF THE WORK FOR WHI HIS PERMIT IS ISSUED , I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO <br /> WORKER'S COMPENSATION LAWS OF CALI NIA " CONTRACTOR 'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING : "I CERTIFY <br /> THAT IN THE PERFORMANCE OF THE W OR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS <br /> OF CALIFORNIA." <br /> Applicant's Signature Title Agent Date 12 / 17/2020 <br /> BILLING INFORMATION : <br /> Indicate the responsible rly to be billed for additi al EHD staff time expended beyond permit payment coverage per <br /> tank. If the party de nated below is differe than the permit applicant, e . g . property owner, the party must <br /> acknowledge this resp risibility for the billing by nature and date below, <br /> NAMEA & S Engineering /Robert Ve4rQEAgent PHONE 0661 -250 - 9300 <br /> ADDRESS 28405 Sand Canyon Ro Suite " B " , Canyon Country CA 91387 <br /> SIGNATURE DATE 12/ 17/2020 <br /> I <br /> 2of6 <br />