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SAN JOAQU. -'OUNTY ENVIRONMENTAL HEALTI PARTMENT SERVICE REQUEST Type of Business or Property FACILITY ID# SERVICE REQUEST# SERVICE STATION FM OWNER/OPERATOR BP ARCO WEST COAST PRODUCTS LLC CHECK If BILLING ADDRESS❑ FACILITY NAME ARCO-7147 SITE ADDRESS 1206 EMARCH LANE STOCKTON F95,210 Street Number Direction Street Name City i Code HOME or MAILING ADDRESS (If Different from Site Address) 6805 SIERRA COURT,SUITE G Street Number Street Name CITY STATE Zip DUBLIN CA 94568 PHONE#1 EXT. APN# LAND USE APPLICATION# ( 925 ) 551.7555 PHONE#2 EXT. BOS DISTRICT LOCATION CODE ( ) CONTRACTOR/ SERVICE REQUESTOR REQUESTOR MERLIN BOWEN CHECK If BILLING ADDRESS BUSINESS NAME Gettler Ryan Inc. PHONE# EXT. 925 551.7555 HOME or MAILING ADDRESS FAx# 6805 SIERRA COURT,SUITE G ( 925 ) 551-7888 CITY DUBLIN STATE CA Zip 94568 BILLING ACKNOWLEDGEMENT: I, the undersigned property or business owner, operator or authorized agent of same, acknowledge that all site and/or project specific ENVIRONMENTAL HEALTH DEPARTMENT hourly charges associated with this project or activity will be billed to me or my business as identified on this form. 1 also certify that I have prepared this application and that the work to be performed will be done in accordance with all SAN JOAQUIN COUNTY Ordinance Codes,Standards,STATE and FEDERAL laws. APPLICANT'S SIGNATURE: 4f��/ DATE: Z t� PROPERTY/BUSINESS OWNER❑ OPERATOR/MANAGER ❑ OTHER AUTHORIZED AGENT Qr A ent for Owner 1—AV-AA • IfAPPLICANT is not the BILLING PARTY proof of authorization to sign is required T1tRje AUTHORIZATION TO RELEASE INFORMATION: When applicable, I, the owner or operator of the property Icatedy o above site address, hereby authorize the release of any and all results, geotechnical data and/or environment/ etre s s ent information to the SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT as soon as it is available aml at the same rr s provided to me or my representative. QAPE �OgQU1/10 IN C TYPE OF SERVICE REQUESTED: OVERFILL VALVE INSTALLATIONLTN DFpARTTAL Mp COMMENTS: REMOVE EXISTING DROP TUBES AND VENT BALL FLOAT CAGES AND INSTALL NEW OPW-71SO OVERFILL PROTECTION VALVES IN ALL LISTS,REMOVE EXISTING LINE LEAK DETECTORS AND REPLACE WITH NEW PLLD'S IN ALL TURBINES,REPLACE EXISTING VEEDOR ROOT 205 SENSORS IN REGULAR AND PREMIUM TURBINE SUMPS WITH NEW VEEDOR ROOT 208 SENSORS,REMOVE EXISTING 407 ANNULAR TANK SPACE SENSOR WITH NEW VEEDOR ROOT 409 TANK ANNULAR SENSOR.PERFORM COLD START, ACCEPTED BY: EMPLOYEE#: 1)n r DATE: ( I� ASSIGNED TO: b�y r k EMPLOYEE#: O 221 DATE: ' ( a •U Date Service Completed (if already completed): SERVICE CODE: ICf P 1 E: Fee Amount: Amount Paid �� Payment Date /� lg JVD Payment Type Invoice# Check# ��6 Received By: EHD 48-02-025 SR FORM(Golden Rod) REVISED 11/17/2003