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19255517883, Main Fax GETTLER RYAN INC 40 p.m. 08-11-2008 5/11 <br /> 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <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 /> 116 <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE BELOW: <br /> 11 TANK RETROFIT EPIPING REPAIR/RETROFIT I_JIUDC REPAIR/RETROFIT <br /> F EPA site# CAL000225719 Project Contact&Telephone# Liddv McKenzie (925.551.7555) <br /> C Facility Name ARCO 2133 Phone# (209)478-5552 <br /> 1 Address 2908 BENJAMIN HOLT DR, STOCKTON, CA 95207 <br /> L <br /> I cross Street PLYMOUTH RD <br /> Y Owner/Operator BP West Coast Products LLC Phone# <br /> o Contractor Name Gettler-Ryan Inc Phone# (925) 551-7555 <br /> N Contractor Address 6747 SIERRA CT,SUITE J,DUBLIN,CA94568 CA Lic# 220793 Class n.Bc,o.cs.c-e,:o+�.,,�a K <br /> T <br /> A Insurer STATE COMPENSATION INS FUND work Comp# 238-0003058 <br /> T ICC Technician's Certification Number 5322633-UT Expiration Date 01!07/2009 <br /> Q ICC Installer's Certification Number 5296364-UI Expiration Date 05/25/2009 <br /> R <br /> Tank ID# Tank Size Chemicals Stored Date UST Installed <br /> Currently/Previously <br /> T <br /> A <br /> N <br /> K <br /> P :..Approved �Opproved with conditions I Disapproved <br /> L (See Attachment With Conditions) <br /> A <br /> N Plan Reviewers Name Date f U <br /> APPLICANT MUST PERFORM ALL WORWINVACCORDANCE 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 /> WORKER'S COMPENSATION LAWS OF CALIFORNIA" CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY <br /> THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS <br /> OF CALIFORNIA." <br /> Applicants Signature Tata AGENT FOR OWNER Date 8/11/2008 <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 party 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 Liddv McKenzie TITLE Project Manaqer PHONE 4 925.551.7555 <br /> ADDRESS 6747 SIER A C SUITE I DUBLIN 94568 <br /> SIGNATURE <br /> EH230038(revised S/ ! <br /> 1 <br />