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SAN JOAQUIN <br />COUNTY -- <br />Environmental Health Department <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 W UDC REPAIR/RETROFIT ❑ COLD START/EVR UPGRADE <br />F <br />EPA Site # <br />Project Contact & Telephone #Travis Bowen 925.551.7555 <br />� <br />Facility Name BP Arco SS# 2186 <br />Phone #209.941.2694 <br />I <br />Address3212 North California St. Stockton CA <br />L <br />I <br />Cross Street E Alpive Ave. <br />T <br />Y <br />owner/OperatorBP ARCO WEST COAST PRODUCTS <br />Phone #847.340.3092 <br />C <br />Contractor Name Nwestco DBA Gettler-Ryan Inc. <br />Phone #925.551.7555 <br />0 <br />N <br />Contractor Address6805 Sierra Court Suite G <br />CA Lic # 1073967 Class A,C61/D40 HAZ <br />T <br />A <br />insurerWestchester Surplus Lines Insurance Company <br />Work Comp #B -7W459264 -24-14-G <br />0 <br />ICC Technician's Name Jon Tim Adams <br />Expiration Date 3/1 /26 <br />T <br />0 <br />R <br />ICC Installer's Name Jon Tim Adams <br />Expiration Date 6/16/25 <br />Tank system work area <br />Tank Size <br />Chemicals Stored Currently <br />Date UST <br />(i.e. 87 piping sump, 91 leak detector, UDC 1/2, etc.) <br />Installed <br />87 slave STP sump <br />10,000 <br />regular unleaded gas <br />7/29/1999 <br />T <br />A <br />N <br />K <br />P <br />❑ Approved ® Approved with conditions ❑ Disapproved <br />L <br />(See Attachment With Conditions) <br />A <br />N <br />Plan Reviewers Name Date 6/23/25 <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 />` P E RM IT T EC H N I C IAN 5/30/25 <br />Applicant's Signature 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 Travis Bowen TITLE Permit Technician PHONE # 925.551.7555 <br />ADDREss 6805 Sierra Court Suite G <br />SIGNATURE / 44� v616VVVI� <br />2of6 <br />TE 5/30/2025 <br />