COMPLIANCE INFO_1999 - 2003 - Laserfiche WebLink

Home Browse Search

San Joaquin County Environmental Health Department 304 E Weber, 3rd Floor Stockton, CA 95202 Application for Underground Tank Retrofit,or piping repair permit This permit expires 90 days from the approval date. Do not write in any shaded areas. Indicate permit type below: Tank Retrofit X Pi in Repair/Retrofit _Under Dispenser Containment.Repair/Permit ....... P 9......... p ....... .....................................................I p ...................�.............................. ._..---.........._._: - EPA SITE# Project Contact&Telephone# Lori Freshour 916 858-1090 FACILITY NAME ARCO 6080 Phone#(209)983-9140 ADDRESS 85 E Louise Ave CROSS STREET 1-5 OWNER/OPERATOR BP West Coast Products, LLC Phone#(209)649-3335 _-------- .................................................................................................................................................................................................................._...........__..._.._..._............._.....-...........................___..._........................-- -.-.... .---..........................................................._...........-.._._._.._...._ - ....._......_ CONTRACTOR NAME Tait Environmental Systems Phone# CONTRACTOR ADDRESS 3283 Luyung Dr CA LIC#588098 Class C10 B A ASB HAZ H1 C INSURER Brakke Schafnitz Work Comp#0092000018502 OTHER INFORMATION Phone# I Phone# 3 —.. ..._.__--- _....................................................................._- ----....__...__....._....................................................----....._........................................................................................................................................................._. ...._........................................................................................._- Tank ID# Tank Size Chemical Stored Currently/'Previously Date UST Installed 39- 87 12000 Gasoline i 39- i 39 39- 39- i 39- I 39- (— �......... :..................................................................................................................................:................................_. _._...._ .�_.._._.._......... .............._._ I Approved proved with Condition(s) —Disapproved Plan Reviewer's Name 1 APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS,AND RULES i AND REGULATIONS OF SAN JOAQUIN COUNTY, ENVIRONMENTAL HEALTH DEPARTMENT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN 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 WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSEUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." — ............................................................................................................. ......................................................................_.. — .....................__......_.._..-—-...._._._..__.._....- .... __ __..—........._ ..................................__........................ APPLICANT'S SIGNATURE: TITLE Compliance Mqr DATE 10/6/03 �._.---.._............................................................................................. ....................................................................................................................................................................— ..------..._...............................................__— _.—_—................................................. Billing Information: Indicate the responsible party to be billed for additional EHD staff time expended beyond permit payment coverage per tank. If the party designated below is different that the permit applicant, e.g. property owner, the party must acknowledge this responsibility for the billing by signature and date below. Name BP West Coast Product, LLC Address_4 Center Pointe Dr, La Palma CA 90623_ Phone# (209)649-3335 Signature 4� S;l— eLbuh EH230038 (revised 1/31/02)