Laserfiche WebLink
19255517888 Main Fax GETTLER RYAN INC 4:52 a.m. 04-29-2008 5/10 <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 />��yy(( THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE BELOW: <br />LrJTANK RETROFIT ❑PIPING REPAIR/RETROFIT ❑UDC REPAIR/RETROFIT <br />F <br />EPA Site # <br />Project Contact & Telephone # Liddy McKenzie (925.551.7555) <br />C <br />Facility Name ARCO 2093 <br />Phone # <br />� <br />Address 3425 TRACY BLVD, TRACY, CA 95376 <br />1 <br />T <br />Cross Street CLOVER <br />Y <br />Owner/Operator BP West Coast Products LLC <br />Phone # <br />G <br />Contractor Name Gettler-Ryan Inc <br />Phone # (925) 551-7555 <br />0 <br />N <br />T <br />Contractor Address 6747 SIERRA CT, SUITE J, DUBLIN, CA94668 <br />CA Lic # 220793 Class A.9.c10,cs7,c.rim4owzHIc <br />A <br />Insurer STATE COMPENSATION INS FUND <br />work Comp # 238-0003058 <br />T <br />T <br />ICC Technician's Certification Number 5300833 -UT <br />Expiration Date 01/17/2009 <br />R <br />ICC Installer's Certification Number 5300833 <br />-UI <br />Expiration Date 12/28/2008 <br />Tank ID # <br />Tank Size <br />Chemicals Stored Date UST Installed <br />Currently/Previously <br />T <br />A <br />N <br />K <br />P <br />❑Approve Approved with conditions ❑Disapproved <br />L <br />( ee Attachment With Conditions) <br />A-4 <br />NPlan <br />lit/ 0 6--' <br />Reviewers Name Date <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAOUI COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF SAN <br />JOAQUIN COUNTY, ENVIRONMENTAL HEALTH DE ARTMENT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN <br />THE PERFORMANCE OF THE WORK FO WHIC IS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO <br />WORKER'S COMPENSATION LAWS CAL N '*CONTRACTORS HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY <br />THAT IN THE PERFORMANCE OF T W 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 Date 4/29/2008 <br />/4/ 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 parry 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 />Z <br />EH230038(revised 8/8/06) <br />1 <br />