Laserfiche WebLink
SANJOAQUIN Environmental Health Department <br /> COUNTY <br /> APPLICATION FOR UNDERGROUND STORAGE TANK <br /> CLOSURE PERMIT <br /> THIS PERMIT FOR PERMANENT/TEMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS <br /> SUBSTANCES STORAGE TANK(S ) EXPIRES 180 DAYS FROM THE APPROVAL DATE . DO NOT WRITE IN ANY SHADED AREAS , <br /> INDICATE PERMIT TYPE : <br /> REMOVAL ❑ TEMPORARY CLOSURE ❑ CLOSURE IN PLACE <br /> FACILITY INFORMATION <br /> EPA SITE # CAR000269274 PROJECT CONTACT Daryl Lee , Retail Compliance Coord . PHONE# 415 902 =5089 <br /> FACILITY NAME ARCO am/pm Fuel Facility FAC #7049 PHONE # 209 334.3678 <br /> ADDRESS 800 East Kettleman Lane , Lodi CA 95240 <br /> CROSS STREET CA Highway 99 <br /> OWNER OPERATOR BP West Coast Products , LLC PHONE # ( 360 ) 371o1500 <br /> CONTRACTOR INFORMATION <br /> CONTRACTOR NAME Town & CountrV Contractors Inc . PHONE # 916 636=9500 <br /> CONTRACTOR ADDRESS 3206 Luyung Drive , Rancho Cordova , CA 95742 CA LIC # 238112 CLASS A , B HAZ <br /> INSURER State Compensation Fund WORKER COMP# 921878218 <br /> FIRE DISTRICT City of Lodi CA PERMIT # <br /> LABORATORY NAME Eurofins TestAmerica COUNTY Orange I PHONE # (949 ) 261w1022 <br /> SAMPLING FIRM Antea Group PHONE # 800 477-7411 <br /> TANK INFORMATION <br /> TANK ID # TANK SIZE TANK CONTENTS PRESENT AND PAST DATE INSTALLED <br /> 39 - 10339507-001 103000 Regular Unleaded Gasoline 11111992 <br /> 39 - 10339507-002 10 , 000 Regular Unleaded Gasoline 11111992 <br /> 39 - 10339507-003 10 , 000 Regular Unleaded Gasoline 11111992 <br /> 39 - 10339507= 004 109000 Premium Unleaded Gasoline 11111992 <br /> 39 - <br /> 39 - <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WTH SAN JOAQUIN COUNTY ORDINANCES , STATE LAWS , FEDERAL LAWS, AND RULES AND <br /> REGULATIONS OF SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT . OWNER OR, LICENSED AGENT 'S SIGNATURE CERTIFIES THF <br /> FOI I OWNG ' I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED , I SHALL NOT EMPLOY ANY PERSON IN SUCH <br /> A MANNER AS TO BECOME SUBJECT TO lN9RKE- R-° --C'O'vftp4SATION I AWS OF CALIFORNIA. • CONTRACTOR v HIRING OR SUBCONTRACTING <br /> SIGNATURE CERTIFIES THE FOLLCNAIJ 2ER? IFY. 1AX1N `! E.-PERFORMANCE OF 1HE WORK FOR h' r11CH THIS PERMIT IS ISSUED , I SHALL <br /> EMPLOY PERSONS SUBJECT TO WO IfER'S COP11P N T GN CXWS OF CALIFORNIA ,' <br /> APPLICANT' S SIGNATUFy ' TITLE r � DATE / z/ <br /> ❑ APPROVED ❑ APPROVED WITH CONDITION ( S ) ❑ DISAPPROVED <br /> (SEE CONDITIONS BELOW AND/OR ON ATTACHMENT ) <br /> PLAN REVIEWER' S NAME DATE <br /> ANY DEVIATIONS FROM THIS APPLICATION MUST BE SUBMITTED TO EHD FOR APPROVAL PRIOR TO COMMENCING WORK. <br /> CONDITIONS : <br /> 10of10 <br />