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92555178^808 Line 1 :02 a.m. 09-15-2008 5110 <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 />�� <br />yy(( THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE BELOW: <br />W1TANK RETROFIT ❑PIPING REPAIRlRETROFIT ❑UDC REPAIRIRETROFIT <br />F <br />EPA Site # CAL000225719 <br />Project Contact & Telephone # Liddy McKenzie (925.551.7555) <br />C <br />Facility Name ARCO 2130 <br />Phone # 209,957,2987 <br />I <br />L <br />Address 7906 EL DORADO ST, STOCKTON, CA 95210 <br />1 <br />T <br />Cross street PLYMOUTH RD <br />Y <br />Owner/Operator BP West Coast Products LLC <br />Phone # <br />o <br />Contractor Name Gettler-Ryan Inc <br />Phone# (925) 551-7555 <br />N <br />Contractor Address 6747 SIERRA CT, SUITE J, DUBLIN, CA94568 <br />CA Lic # 220793 Class as,c,acw,cs,roaownzHic <br />A <br />insurer STATE COMPENSATION INS FUND <br />Work Comp# 238-0003058 <br />T <br />r <br />IGC Technician's Certification Number 5259192 -UT <br />Expiration Date 05/18/2009 <br />R <br />ICC Installer's Certification Number 5259192 -UI <br />Expiration Date 12/20/2009 <br />Tank ID # <br />Tank Size <br />Chemicals Stored <br />Currently/Previously <br />Date UST Installed <br />T <br />A <br />N <br />K <br />P <br />❑Approved pproved with conditions p� ❑Disa proved <br />L <br />Se Attachment With Conditions) r/ Z <br />N <br />Plan Reviewers NaM0010//�'�%� 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 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 Title AGENT FOR OWNER Date 09/12/2008 <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 parry must acknowledge this <br />responsibility for the billing by signature and date below. <br />NAME Liddy McKenzie TITLE Proiect Manaqer PHONE # 925.551.7555 <br />EH230038 (revised 8/8/06) <br />1 <br />