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0 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY RECEIVED <br /> - r 1868 E. Hazelton Ave., Stockton, California 95205 <br /> ?� Telephone: (209) 468-3420 Fax: (209) 468-3433 <br /> PLICATION FOR UNDERGROUND STORAGE TANK ENVIRONMENTAL <br /> RETROFIT OR PIPING REPAIR PERMIT HEALTH"?FPAr4TMEN1 <br /> THIS PERMIT EXPIRES 180 DAYS FROM THE APPROVAL DATE_ INDICATE PERMIT TYPE BELOW. <br /> 0 TANK RETROFIT 0 PIPING REPAIRIRETROFrr D UDC REPAIRIRETROFIT a COLD STARTIM UPGRADE <br /> F EPA Site# Project Contact&Telephone*MERLIN BOWEN 925.551.7555 <br /> A <br /> C Facillty Name ARCO SS#2093 Phone#209,835.1605 <br /> I <br /> L Address 3425 TRACY BLVD <br /> F Cross Street W CLOVER STREET <br /> Y Owner/OperatorBP ARCO WEST COAST PRODUCTS LLC Phone#530.470.6133 <br /> C Contractor 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 AIB/C61-D40/CIC <br /> A InsurerState Compensation Ins Fund Work Comp 09051229-3 <br /> C <br /> T ICC Technician's Name PAVAL KIRCHIOGLO Expiration Date 6/12/2020 <br /> R <br /> ICG Installer's Name PAVAL KIRCHIOGLO Expiration Date 6112/2020 <br /> Tank system work area Tank Size Chemicals Stored Currently Date UST <br /> G is e7 p"V WW,01 INk dalWar,UDC IQ.rc) Installed <br /> T L5 SENSOR IN REGULAR UST STP 10,000 GASOLINE UNKNOWN <br /> A <br /> N <br /> K <br /> p 'D Approved NAachment <br /> Approved with conditions Disapproved <br /> L (See With Conditions) <br /> A <br /> N l� <br /> Plan Reviewers Name <br /> APPLICANT MUST PERFORM ALL WORK IN ACC��IIN JOAQUIN COUNTY ORDINANCES.STATE LAWS.AND RULES AND REGULATIONS OF SAN <br /> OAOUIN COUNTY,ENVIRONMENTAL HEALTH DEPARTMENT.OWNER OR LICENSED AGENTS 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 /> AT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS <br /> F CALIFORNIA." <br /> AGENT FOR OWNER 9/12/2018 <br /> T;d X <br /> BILLING INFORMATION: <br /> Indicate the responsible party be billed for additional EHD staff tine 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#925.559.7555 <br /> ADORES6805 SIERRA CT, SUITE G, DUBLIN, 94568 �I <br /> SIGNATURE DATE t <br /> EH230038(revised 07-17- 14) <br /> 2 <br />