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dRts <br />t..:,55517888 Line 1WE <br />:55:01 09-09-2013 3112 <br />O <br />a iy <br />- --ENVIRONMENTAL H - ALT - -- DEPARTMENT- <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 />11 TANK RETROFIT El PIPING REPAIRIRETROFIT ❑ UDC REPAIRIRETROFIT 0 COLD STARTtEVR UPGRADE <br />F <br />EPA Site # <br />Project Contact & Telephone #Liddy McKenzie 925.551.7555 <br />C <br />Facility NameARCO # 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 />OwnertOperatorBP West Coast Products LLC <br />Phane # <br />C <br />Contractor Name Gettler Ryan Inc. <br />Phone #$25,551.7555 <br />N <br />T <br />Contractor Address 6747 Sierra Court, Suite J <br />CA Lic # 22om Class, s; cst D4a and HAz <br />A <br />Insurer State Fund <br />work Comp #238-0003058 <br />o <br />T <br />ICC Technician's Name Chris Reeves <br />Expiration Date <br />R <br />[CCInstaller'sInstaller's Name Chris Reeves <br />._ <br />Expiration Date <br />Tank system work area <br />(Le. 87 OZaump� 9I t dahnior. UDC 112, ®ta) <br />Tank Size Chemicals Stored Currently Date UST <br />y Installed <br />T <br />l�tdG20� ISS <br />N/A gasoline N/A <br />K <br />P <br />❑ Approved <br />Approved with conditions ❑ Disapproved <br />L <br />A <br />N <br />{Seg <br />Pian Reviewers Name '� <br />A achment With Conditions) <br />Date <br />--- _ <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF SAN <br />JOAQUIN COUNTY, ENVIRONMENTAL HEALTH DEPARTMENT, OWNER OR LICENSED AGENTS SIGNATURE CERTIFIES THE FOLLOWING "I CERTIFY THAT IN <br />THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO <br />WORKER'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING "I CERTIFY <br />THAT IN THE PERFORMANCE OF RK F R WHICH THIS PERMIT <br />IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT To WORKER'S COMPENSATION LANE <br />F CALIFORNW <br />Appiicanfs Signator° Date 910 2/2013 <br />pr A— <br />BILLING INFORMATION: <br />Indicate the responsible party to be billed for additional EHD staff time expended beyond permit payment coverage per tank. If <br />the party designated below is different than the permit applicant, e.g.. property owner, the party must acknowledge this <br />responsibility for the billing by signature and date below. <br />NAME Liddy McKenzie TITLE 91P 912 013PKONEWL 925.551.7555 <br />ADD6747 Sierra Co ui , Dublin, CA. 94568 <br />REs$_ <br />EH230038 (revised 10130112) <br />2 <br />6l` 2013 <br />