Laserfiche WebLink
ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> 1868 E . Hazelton Ave . , Stockton , California 95205 <br /> Telephone : ( 209 ) 468 -3420 Fax : (209 ) 468 - 3433 <br /> APPLICATION FOR UNDERGROUND STORAGE TANK <br /> RETROFIT OR PIPING REPAIR PERMIT <br /> THIS PERMIT EXPIRES 180 DAYS FROM THE APPROVAL DATE , INDICATE PERMIT TYPE BELOW: <br /> ❑ TANK RETROFIT ❑ PIPING REPAIR/RETROFIT ❑ UDC REPAIR/RETROFIT ❑ COLD START/EVR UPGRADE <br /> F EPA Site # Project Contact & Telephone # MERLIN BOWEN 925 . 551 . 7555 <br /> A <br /> C Facility Name ARCO SS# 6080 Phone # <br /> I Address85 E LOUISE AVENUE <br /> L <br /> I Cross Street <br /> T <br /> Y Owner/OperatorBP WEST COAST PRODUCTS LLC Phone # 530 . 771 -8942 <br /> o Contractor Name Gettler Ryan Inc. Phone # 925 , 551 , 7555 <br /> T Contractor Address 6805 Sierra Court , Suite G , SUITE G CA Lic # 220793 ClassA , B , C61 / D4 , HAZ <br /> R <br /> A InsurerZURICH AMER INS COMPANY Work Comp # WC090463404 <br /> T ICC Technician 's Name DAVID ROUSE Expiration Date 7/ 15/2024 <br /> R ICC Installer's Name DAVID ROUSE Expiration Date 7/30/2024 <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 PREMIUM UNLEADED 20 , 000 87 GASOLINE <br /> A <br /> N <br /> K <br /> P ❑ Approved Approved with conditions ❑ Disapproved <br /> L ( See Attachment With Conditions) <br /> A / 5 <br /> N Plan Reviewers Name — C Date l / 0 ;L <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 /> Applicant's Signature ;�Zay,#* 6&6,oP Title AGENT FOR OWNER Date 3/8/2024 <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 travis bowen TITLE agent for contractor PHONE # 925m55107555 <br /> ADDRESS 6805 SIERRA CT , SUITE G , DUBLIN , 94568 <br /> SIGNATURE 46&u'-L� DATE 3/8/2024 <br /> EH230038 (revised 07- 17-2014) <br /> 2 <br />