Laserfiche WebLink
9255517888 Line 10 27 p.m <br />04-20-2009 5/13 <br />304 East Weber Avenue, Third Floor, Stockton, California 95202 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE BELOW: <br />❑TANK RETROFIT ❑PIPING REPAIRtRETROFIT OUDC REPAIRIRETROFIT <br />F <br />EPA Site # CAL000225719 Project Contact & Telephone # Liddy McKenzie (925.551.7555) <br />G <br />Facility Name ARCO 2130 Phone # 209.957.2987 <br />I <br />L <br />Address 7906 EL DORADO ST, STOCKTON, CA 95210 <br />I <br />T <br />Cross street PLYMOUTH RD <br />Y <br />owner/Operator SIP West Coast Products LLC Phone # <br />o <br />Contractor Name Gettler--RYan Inc Phone# (925) 551-7555 <br />7 <br />Contractor Address 8747 SIERRA CT, SUITE J, DUBLIN, CA94568 CA Lic # 220793 Class Ascmcs7.c-6v wmzw <br />A <br />Insurer STATE COMPENSATION INS FUND <br />work Comp # 238-0003058 <br />C <br />T <br />IGC Technician's Certification Number 5259192 -UT <br />Expiration Date 05/18/2009 <br />R <br />ICC Installer's Certification Number 5259192-Ul <br />Expiration Date 12/20/2009 <br />Tank ID # <br />Tank Size Chemicals Stored Date UST Installed <br />Currently/Previously <br />T <br />A <br />N <br />K <br />P <br />❑Approved proved With conditions ❑Disapproved <br />L <br />— -r (JAttachment With Conditions) <br />A„ <br />N <br />Plan Reviewers Name Date <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS. AND RULES AND REGULATIONS OF SAN <br />JOAQUIN 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 />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 />AppiicantsSignature MERLIN BOWEN TiUe AGENT FOR OWNER Date <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 Manaqer PHONE # 925.551.7555 <br />'47 <br />EH230038 (revised 8/8/06) <br />0 <br />