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SANJOAQUIN Environmental Health Department <br /> COUNTY � 7CEIVE ), <br /> APPLICATION FOR UNDERGROUND STORAGE TANK DEC Q 8 2022 <br /> RETROFIT OR PIPING REPAIR PERMIT <br /> THIS PERMIT EXPIRES 180 DAYS FROM THE APPROVAL DATE , INDICATE PERMIT TYPE BELOW: -. NVIRU ►VMENTAL HEAD, HRVICES <br /> ❑ TANK RETROFIT ❑ PIPING REPAIR/RETROFIT ❑ UDC REPAIR/RETROFIT ❑ COLD START/EVR IJI� �1�E� <br /> F EPA Site # Project Contact & Telephone # Merlin Bowen 925 . 551 -7555 <br /> � Facility Name ARCO #7147 Phone # 203 . 956-2032 <br /> I Address 1206 East March Lane <br /> L <br /> Cross Street <br /> et <br /> Y Owner/OperatorBP/ARCO West Coast Products LLC Phone # 847 . 340 -3092 <br /> o Contractor Name Gettler- Ryan , Inc . Phone # 925 . 551 . 7555 <br /> N Contractor Address 6805 Sierra Court, Suite G CA Lic # Class <br /> T <br /> AInsurer Zurich American Insurance Company Work Comp # WC090463403 <br /> C <br /> T ICC Technician ' s NameMatthew Campbell Expiration Date 3/31 /2024 <br /> R ICC Installer's Name John Li Expiration Date 2/03/2024 <br /> Tank system work area Tank Size Chemicals Stored Currently Date UST <br /> (i.e. 87 piping sump, 91 leak detector, UDC 1/2, etc.) Installed <br /> T turbine replacement 10 , 000 87 gasoline fuel <br /> A turbine replacement 10 , 000 91 gasoline fuel <br /> N <br /> K turbine replacement 10 , 000 diesel fuel <br /> P ❑ Approved Approved with conditions ❑ Disapproved <br /> L ee Attachment With Conditions) <br /> N Plan Reviewers Namei P DateTi'EV ' <, <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 /> Permit Tech i . <br /> Applicant's Signature t � �( " Title Date <br /> BILLING INFORMATION : <br /> Indicate the responsible party to be billed for additional EHD staff time expended beyond permit payment coverage per <br /> tank. If the party designated below is different than the permit applicant, e . g . property owner, the party must <br /> acknowledge this responsibility for the billing by signature and date below. <br /> NAME Merlin Bowen (agent for contractor) TITLE Permit Tech PHONE # 925 . 551 -7555 <br /> ADDRESS 6805 Sierra Court , Suite G , Dublin , CA 94568 <br /> SIGNATURDATE IZ 146) � �Z <br /> 2 of 6 <br />