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ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY RECEIVED <br /> 1868 E. Hazelton Ave., Stockton, California 95205 <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 StP Is 201$ <br /> "° LICATION FOR UNDERGROUND STORAGE TANK ENVIRONMENTAL <br /> RETROFIT OR PIPING REPAIR PERMIT HEALTH rXFpaRTMENT <br /> THIS PERMIT EXPIRES 180 DAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE BELOW: <br /> ❑TANK RETROFIT ❑PIPING REPAIR/RETROFIT ❑UDC REPAIRIRETROFIT ❑COLD START/EVR UPGRADE <br /> F EPA Site# Project Contact&Telephone#MERLIN BOWEN 925.551.7555 <br /> A <br /> C Facility Name ARCO SS#2093 Phone#209.835.1605 <br /> I <br /> L Address 3425 TRACY BLVD <br /> T Cross Street W CLOVER STREET <br /> Y Owner/OperatorBP ARCO WEST COAST PRODUCTS LLC Phone#530.470.6133 <br /> cContractor Name Gettler Ryan Inc. Phone#925.551.7555 <br /> 0 <br /> N Contractor Address 6805 Sierra Court, Suite G, SUITE G <br /> T CA Lic#220793 Class A/B/C61-D40/CI <br /> A Insurer State Compensation Ins Fund Work Comp#9051229-3 <br /> C <br /> T ICC Technician's Name PAVAL KIRCHIOGLO Expiration Date 6/12/2020 <br /> o <br /> R ICC Installer's Name PAVAL KIRCHIOGLO Expiration Date 6/12/2020 <br /> Tank system work area Tank Size Chemicals Stored Currently Date UST <br /> (i.e.87 piping sump,91 leak detector,UDC 1/2,etc.) Installed <br /> T L5 SENSOR IN REGULAR UST STP 10,000 GASOLINE UNKNOWN <br /> A <br /> N <br /> K <br /> P ❑ Approved Nachment <br /> pproved with conditions El Disapproved <br /> L (See With Conditions) <br /> A .'' rr �� <br /> N Plan Reviewers Name Date (� `'� ( 9) <br /> APPLICANT MUST PERFORM ALL WORK IN ACCO TH JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN <br /> JOAQUIN COUNTY, ENVIRONMENTAL HEALTH DEPAR MENT. 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 /> Applicant'sSignature v Title AGENT FOR OWNER Date 9/12/2018 <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 Liddy McKenzie TITLE Project Manager PHONE#925.551.7555 <br /> ADDRESS 6805 SIERRA CT, SUITE G, DUBLIN, 94568 4 <br /> SIGNATURE DATE7L tl <br /> EH230038(revised 07-17-914) <br /> 2 <br />