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;19255517888 Main Fax GETTLER RYAN INC 5:30 a.m. 10-17-2007 215 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> 304 East Weber Avenue,Third Floor,Stockton,California 95202 <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 <br /> APPLICATION FOR UNDERGROUND STORAGE TANK RETROFIT OR PIPING REPAIR PERMIT <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE <br /> BELOW: <br /> YJ <br /> `[TANK RETROFIT PIPING REPAIR/RETROFIT UIIUDC REPAIR/RETROFIT <br /> F EPA Site# CAL000225805 Project Contact&Telephone# Liddy McKenzie (925.551.7555) <br /> C Facility Name ARCO 6080 Phone# (209) 983-9140 <br /> I L Address 85 E LOUISE AVE, LATHROP, CA 95330 <br /> Cross Street <br /> T <br /> Y Owner/Operator BP West Coast Products LLC Phone# <br /> o Contractor Name Gettler-Ryan Inc Phone# (925) 551-7555 <br /> N Contractor Address 6747 SIERRA CT,SUITE I DUBLIN.CA94568 CA Lic# 220793 Class nEc+acs.ce+io o.Nnz uc <br /> T <br /> A Insurer STATE COMPENSATION INS FUND work Comp# 238-000305$ <br /> T ICC Technician's Certification Number 5300833-UT Expiration Date 12/28/2009 <br /> DICC Installer's Certification Number 5300833-UI Expiration Date 12/28/2009 <br /> R <br /> Tank ID# Tank Size Chemicals Stored Date UST Installed <br /> Currently/Previously <br /> T <br /> A <br /> N <br /> K <br /> P ,]Approved L�Approved with conditions ❑Disapproved <br /> L (See Attachment With Conditions) <br /> N Plan Reviewers Name /1J,1A4,- Date <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 F 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 C ORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY <br /> THAT IN THE PERFORMANCE OF T K FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS <br /> OF CALIFORNIA." <br /> Applicants Signature Title AGENT FOR OWNER Dale 10/16/2007 <br /> BILLING INFORMATION: <br /> Indicate the responsi arty 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 Liddy McKenzie TITLE Project Manager -PHONE#-925.551.7555 <br /> ADDRESS 6747 SIERRA Y, SUOE J DUBLIN 94568 <br /> SIGNATURE C�4 //,1 <br /> EH230038(revised 8/8106 <br /> 1 <br />