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19255517888 Main Fax GETTLER RYAN INC 0 :33 p.m. 10-10-2007 3/11 <br /> ENVIRONMENTAL <br /> SAN JOAQUIN COUNTY <br /> 304 East Weber Avenue,Third Floor,Stockton,California 95202 <br /> Telephone: (209)468-3420 Fax: (209)468-3433 <br /> APPLICATION FOR UNDERGROUND STORAGE TANK RETROFIT OR PIPING REPAIR PERMIT <br /> THIS PERMIT EXPIRES 80 DAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE BELOW: <br /> ❑TANK RETROFIT 61PING REPAIR/RETROFIT ❑UDC REPAIR/RETROFIT <br /> F EPA Site# CAL000225719 Project Contact&Telephone# Liddy McKenzie(925.551.7555) <br /> � <br /> Facility Name ARCO 2133 Phone# (209)478-5552 <br /> I Address 2908 BENJAMIN HOLT DR, STOCKTON, CA 95207 <br /> L <br /> T <br /> Cross Street PLYMOUTH RD <br /> Y owner/Operator BP West Coast Products LLC Phone# <br /> C Contractor Name Gettler-Ryan Inc Phone# (925) 551-7555 <br /> N Contractor Address 6747 SIERRA CT,SUITE J,DUBLIN,CA94568 CA Lic# 220793 Class <br /> T as.c+ocsr.casvw,rwzwc <br /> A insurer STATE COMPENSATION INS FUND work comp# 238-0003058 <br /> cICC Technician's Certification Number 5252314-UT Expiration Date 05/18/2009 <br /> T <br /> R I ICC Installer's Certification Number 5252314-Ul Expiration Date 12/28/2008 <br /> Tank ID# Tank Size Chemicals Stored Date UST Installed <br /> Currently/Previously <br /> T <br /> A <br /> N <br /> K <br /> P DApproved E6Approved with conditions ❑Disapproved <br /> L (See Attachment with Conditions) <br /> A <br /> N Plan Reviewers Name Date IO IlizIq <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORIJANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN <br /> JOAQUIN COUNTY,ENVIRONMENTAL HEALTH DEPARTMENT.OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN <br /> 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 <br /> WORKERS COMPENSATION LAWS OF CALIFORNIA." CONT. CTORS HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY <br /> THAT IN THE PERFORMANCE OF THE WORK F WHIC PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKERS COMPENSATION LAWS <br /> OF CALIFORNIA." <br /> Applicants Signature ;6� Titie AGENT FOR OWNER Date 10/10/2007 <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 parry 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 /> NAME <br /> Liddy McKenzie TITLE Project Manaqer PHONE# 925.551.7555 <br /> ADDRESS 6747 SIERRA CT UITE J DUBLIN, 94568 <br /> SIGNATURE <br /> EH230038(revised 8/8/06) <br /> 1 <br />