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ill <br />.' l 1 -9 � <br />SAN JOAQUIN COUNTY <br />1868 E. Hazelton Ave., Stockton, California 95205 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />THIS PERMIT EXPIRES 180 DAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE BELOW: <br />❑ TANK RETROFIT ❑ PIPING REPAIRIRETROFIT ❑ UDC REPAIRIRETROFIT ❑ COLD START/EVR UPGRADE <br />F <br />EPA Site # <br />Project Contact & Telephone # Liddy McKenzie 925.551.7555 <br />C <br />Facility Name ARCO # 5450 <br />Phone #209.462.1617 <br />I <br />L <br />Address 1617 W. Fremont Street <br />TCross <br />Street 1-5 <br />Y <br />Owner/OperatorBP West Coast Products LLC <br />Phone # <br />C <br />Contractor Name Gettler Ryan Inc. <br />Phone #925.551.7555 <br />0 <br />N <br />Contractor Address 6747 Sierra Court, Suite J <br />CA Lic # 220793 Classn, B. C61 D40 and HAZ <br />T <br />R <br />A <br />Insurer State Fund <br />Work Comp #238-0003058 <br />C <br />T <br />ICC Technician's Name Chris Reeves <br />Expiration Date9/13/2013 <br />0 <br />R <br />ICC Installer's Name Chris Reeves <br />Expiration Date 9/13/2013 <br />Tank system work area <br />UDC <br />Tank Size <br />Chemicals Stored Currently <br />Date UST <br />Installed <br />((e. 87 piping sump, 91 leak detWor, M. etc.) <br />T <br />91 tank sump sensor <br />/A <br />gasoline <br />N/A <br />A <br />N <br />K <br />P <br />❑ Approved <br />Approved with conditions ❑ Disapproved <br />L <br />(Se&achment <br />With Conditions) <br />A <br />N <br />Plan Reviewers Name <br />:—)Date / <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF SAN <br />JOAQUIN <br />COUNTY, ENVIRONMENTAL HEALTH DEPARTMENT. OWNER OR LICENSED AGENTS 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 />WORKER'S COMPENSATION LAVAS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY <br />THAT IN THE PERFORMANCE OF THEAWORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS <br />OF CALIFORNIA." <br />9/13/2013 6/12/2013 <br />Applicant's Signature T1118 Date <br />,/ 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 9/13/2013 PHONE # 925.551.7555 <br />EH230038 (revised 10/30/12) <br />2 <br />6/12/2013 <br />