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ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> 1868 E . Hazelton Ave . , Stockton , California 95205 <br /> Telephone : (209 ) 468 -3420 Fax : (209 ) 468 - 3433 <br /> APPLICATION FOR UNDERGROUND STORAGE TANK <br /> RETROFIT OR PIPING REPAIR PERMIT <br /> THIS PERMIT EXPIRES 180 DAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE BELOW: <br /> ❑ TANK RETROFIT ❑ PIPING REPAIR/RETROFIT ❑ UDC REPAIR/RETROFIT ❑ COLD START/EVR UPGRADE <br /> F EPA Site # Project Contact & Telephone # MERLIN BOWEN 925 . 551 . 7555 <br /> � Facility Name ARCO SS# 2093 Phone # 209 . 835 . 1605 <br /> I <br /> L Address 3425 TRACY BLVD . <br /> T Cross Street W CLOVER ROAD <br /> Y Owner/OperatorBP WEST COAST PRODUCTS LLC Phone # 530 . 771 -8942 <br /> C Contractor Name Gettler Ryan Inc . Phone # 925 . 551 . 7555 <br /> 0 <br /> N Contractor Address 6805 Sierra Court, Suite G , SUITE G CA Lie # 220793 Class A/ B/C61 - D4 /CII <br /> T <br /> A Insurer State Compensation Ins Fund Work Comp # WC090463402 <br /> T ICC Technician 's Name MIKE O 'SULLIVAN Expiration Date 5/26/2023 <br /> R ICC Installer' s Name MIKE O ' SULLIVAN Expiration Date 12/29/2022 <br /> Tank system work area Tank Size Chemicals Stored Currently Date UST <br /> (i.e. 87 piping sump, 91 leak detector, UDC 1 /2, etc. ) Installed <br /> T PREMIUM UNLEADED 10 , 000 GASOLINE <br /> A REGULAR UNLEADED 10 , 000 GASOLINE <br /> N <br /> K REGULAR UNLEADED 10 , 000 GASOLINE <br /> REGULAR UNLEADED 10 , 000 GASOLINE <br /> P ❑ Approved Approved with conditions ❑ Disapproved <br /> L (See Attachment With Conditions) <br /> A <br /> N Plan Reviewers Name Date C' 20 2 <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 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 /> WORKER'S COMPENSATION LAWS OF CALIFORNIA. " CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING : "I CERTIFY <br /> THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED , I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS <br /> OF CALIFORNIA." <br /> Applicant's Signature � � - Title AGENT FOR OWNER 3/25/2022 <br /> 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 Project Manager PHONE # 925 . 551 . 7555 <br /> ADDRESS 6805 TERRA CT , SUITE G , DUBLIN , 94568 <br /> SIGNATURE " ' DATE <br /> i <br /> EH230038 ( revised 07- 17 -2014) <br /> 2 <br />