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9255517888 Line 1 01 4:54:09 09-04-2012 4/13 <br />SAN JOAQUIN COUNTY <br />600 East Main Street, Stockton, California 95202 <br />Telephone; (209) 468-3420 Fax: (209) 468-3433 <br />THIS PERMIT EXPIRES 180 DAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE BELOW: <br />1Z TANK RETROFIT ❑ PIPING REPAIR/RETROFIT ❑ UDC REPAIR/RETROFIT ❑ COLD START/EVR UPGRADE <br />F <br />EPA Site # Project Contact & Telephone # Liddy McKenzie (925.551.7555) <br />A <br />c <br />Facility NameARCO 2093 Phone # <br />I <br />Address 3425 TRACY BLVD, TRACY, CA 95376 <br />T <br />Cross Street CLOVER <br />Y <br />OwnerlOperator BP West Coast Products LLC <br />Phone # <br />o <br />Contractor NameGettler-Ryan Inc <br />Phone # (925) 551-7555 <br />T <br />Contractor Address 6747 SIERRA CT, SUITE J. DUBLIN, CA94568 <br />CA I_ic # 220793 Class4actac571-810ro,e am <br />A <br />insurer STATE COMPENSATION INS FUND work Comp # DTJUB78P41510 <br />T <br />ICC Technician's Name Chris San Nicolas Expiration Date 12/10/2012 <br />R <br />ICC Installer's Name Expiration Date <br />Tank system work area <br />Q.e. 87 piping sump, 81 leak detector, UDC W. etc.) <br />Tank Size <br />Chemicals Stored Currents y <br />Date UST <br />Installed <br />T <br />A <br />N <br />K <br />P <br />❑ Approved proved with conditions ❑ Disapproved <br />L <br />(See kttachovnt With Conditions) <br />A <br />N <br />Plan Reviewers Name 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 AGENTS SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN <br />THE PERFORMANCE OF THE WORK FQ ICH THIS PE SSIJ D, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT <br />TO WORKER'S COMPENSATION LAWS CALIFOR . CONT CTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY <br />THAT IN THE PER OF TH RK ICH T ERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS <br />OF CALIFORNIA." <br />Applicant's Signature Tide AGENT FOR OWNER Date09/04/2012 <br />111111111 .111 q I ` LIP110l &1V11UM141011 <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 />NAMELiddy McKenzie TITLE Project Manager PHONE #925,551.7555 <br />EH230038 (revised 02/20109) <br />1 <br />,G'ii/Lrr <br />