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SANJOAQUIN Environmental Health Department <br /> -COUNTY - -- <br /> APPLICATION FOR UNDERGROUND STORAGE TANK INSTALLATION PERMIT <br /> THE APPLICATION FOR INSTALLATION OF UNDERGROUND STORAGE TANKS IS ONLY VALID FOR THE CALENDAR YEAR IN WHICH IT HAS BEEN <br /> ISSUED A PERMIT MAY BE EXTENDED INTO THE NEXT CALENDAR YEAR IF A LETTER IS SENT TO EHD REQUESTING THIS EXTENSION THIRTY <br /> DAYS PRIOR TO THE END OF THE CALENDAR YEAR A ONE TIME, ONE YEAR EXTENSION MAY BE GRANTED BY EHD UPON RECEIPT OF THIS <br /> LETTER. <br /> PROJECT CONTACT: CONTACT PHONE# <br /> A & S Engineering/Robert Velasco 661-250-9300 <br /> FACILITY NAME: FACILITY PHONE# <br /> BP Arco AM/PM 661-250-9300 <br /> FACILITY ADDRESS: CROSS STREET: <br /> 9036 Thornton Road, Stockton CA 95209 Waudman Avenue <br /> OWNER/OPERATOR: PHONE: <br /> BP Products North America Inc. 661-250-9300 <br /> CONTRACTOR NAME: PHONE: <br /> Town & Country Contractors Inc. 916-636-9500 <br /> CONTRACTOR ADDRESS: CA LICENSE# <br /> 3206 Luyung Drive, Rancho Cordova CA 95742 238112 <br /> HAZARDOUS WASTE CERTIFICATE: WORKERS COMP# <br /> X YES NO 9218782 <br /> FIRE DISTRICT: PERMIT# <br /> Stockton Fire Department BP23-09415 / BP23-09416 / BP23-09419 <br /> TANK ID# TANK SIZE CHEMICAL STORED PROPOSED INSTALL DATE <br /> 1 25000 87 Product 4/1/2024 <br /> 2 12000 91 Product 4/1/2024 <br /> 3 10000 Diesel Product 4/1/2024 <br /> ❑APPROVED ❑APPROVED WITH CONDITIONS ❑DISAPPROVED <br /> (see attachments) <br /> PLAN REVIEWER'S NAME DATE <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDAN WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS,RULES AND <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH D RTMENT.OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE <br /> FOLLOWING"I CERTIFY THAT IN THE PERFORMANC THE WORK FOR WHICH THIS PERMIT IS ISSUED.,I SHALL NOT EMPLOY <br /> ANY PERSON IN SUCH A MANNER AS TO BE E SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." <br /> CONTRACTOR'S HIRING OR SUBCONTRACTIN IGNATURE CERTIFIES THE FOLLOWING "I CERTIFY THAT IN THE <br /> PERFORMANCE OF THE WORK FOR WHICH PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br /> COMPENSATION LAWS OF CALIFORNIA." <br /> Applicant's Signature <br /> Title Agent rw Date 2/29/2024 <br /> Indicate the responsible party to be bi for addition HD staff time expended beyond the 8-hour minimum installation <br /> payment.The party must acknowledge this responsi 'y for the additional billing by signature and date below. <br /> Name A & S Engineering/Robert Velas o Date 2/29/2024 <br /> Mailing Address 28405 Sand Canyon RC,WR . Suite "B", Canyon Country CA 91387 <br /> Signature Daytime Phone 661-250-9300 <br /> c <br /> 3 of 8 <br />