Laserfiche WebLink
1925551888 Main Fax 0 GETTLER RYAN INC 01:53 a.m. 01-15-2008 4/10 <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 />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE BELOW: <br />❑TANK RETROFIT IFIMPING REPAIR/RETROFIT 11UDC REPAIR/RETROFIT <br />F <br />EPA Site # <br />Project Contact & Telephone # Liddy McKenzie (925.551.7555) <br />A <br />C <br />Facility Name ARCO 2093 <br />Phone # <br />� <br />Address 3425 TRACY BLVD, TRACY, CA 95376 <br />I <br />T <br />Cross Street CLOVER <br />Y <br />Owner/Operator BP West Coast Products LLC <br />Phone # <br />C <br />Contractor Name Gettler-Ryan Inc <br />Phone (925) 551-7555 <br />T <br />Contractor Address 6747 SIERRA CT, SUITE J, DUBLIN, CA94568 CA Lic # 220793 Class A.e.c,ocs,.os, wo.w¢H1c <br />A <br />Insurer STATE COMPENSATION INS FUND <br />Work Comp# 238-0003058 <br />C <br />ICC Technician's Certification Number 5250451 -UT <br />Expiration Date 01/17/2009 <br />R <br />ICC Installer's Certification Number 5250451 <br />-UI <br />Expiration Date 05/25/2009 <br />Tank ED # <br />Tank Size <br />Chemicals Stored <br />Currently/Previously <br />Date UST Installed <br />T <br />A <br />N <br />K <br />P <br />ElApproved proved with conditions ❑Disapproved <br />L <br />A <br />(S Attachment With Conditions) <br />N <br />v O <br />Plan Reviewers Name_' <br />----�� -- --- -- ------ --- Date ----I---- <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN J UIN 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 />" <br />WORKER'S COMPENSATION LAWS OF CALI R CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY <br />THAT IN THE PERFORMANCE OF THE WO F ICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS <br />OF CALIFORNIA." <br />Applicants Signature______ _ TitleAGENT FOR _OWNER Date 1/141200$________ <br />F 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 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_PrOlect ManaQel _ PHONE # j25_§51 .7555 <br />SIGNATUR <br />EH230038 (revised 8/8/06) <br />1 <br />