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EnvironRet I � EtVrESAN JOAQUIN ® <br /> - -- COU N TY - - JUN 2. 3 2021 <br /> APPLICATION FOR UNDERGROUND STORAGE16 NK <br /> RETROFIT OR PIPING REPAIR PERM1W HEALTH <br /> THIS PERMIT EXPIRES 180 DAYS FROM THE APPROVAL DATE, INDICATE PERMIT TYPE BELOWEPARTMENT <br /> M TANK RETROFIT ❑ PIPING REPAIR/RETROFIT ❑ UDC REPAIR/RETROFIT ❑ COLD START/EVR UPGRADE <br /> F EPA Site # Project Contact & Telephone # Masood Choudhury (909) 620-5962 <br /> A <br /> C Facility Name Frontier California Inc - Manteca CO Phone # (909) 620-5962 <br /> I <br /> L Address 430 W. Center Street, Manteca , CA 95336 <br /> 1 Cross Street Acacia Avenue <br /> T <br /> Y Owner/Operator Frontier California Inc Phone # (909) 620-5962 <br /> CContractor Name SunWest Engineering Constructors , Inc. Phone # (888) 588-8737 <br /> N Contractor Address CA Lic # 703190 Class A, B , Haz <br /> T 4780 Cheyenne Way , Chino , CA 91710 <br /> AInsurer State Compensation Insurance Fund of CA Work Comp # 9243819-20 <br /> C ICC Technician 's Name Expiration Date 8/8/2022 <br /> T Brandon Bowers P <br /> Q <br /> R ICC Installer's Name Brandon Bowers Expiration Date 8/8/2022 <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 Piping Sump 6 , 000 gallon Diesel <br /> A <br /> N <br /> K <br /> P ❑ Approved Approved with conditions ❑ Disapproved <br /> L (See Attachment With Conditions) <br /> A <br /> N Plan Reviewers Name Ivsl� Date 196 1Z , Z <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 Project Manager Date 6/23/21 <br /> BILLING INFORMATION : <br /> Indicate the responsible party to be billed for additional EHD staff time expended beyond permit payment coverage per <br /> tank. If the party designated below is different than the permit applicant, e. g . property owner, the party must <br /> acknowledge this responsibility for the billing by signature and date below. <br /> NAME Vanessa Ortega TITLE Project Manager PHONE # (909) 536-6458 <br /> ADDRESS 4780 Cheyenne Way, Chino , CA 91710 <br /> SIGNATURE DATE <br /> 2of6 <br />