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SAN10 A Q U I N Environmental Health Department <br />COUNTY ---- <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 />N TANK RETROFIT ❑ PIPING REPAIR/RETROFIT ❑ UDC REPAIR/RETROFIT ❑ COLD START/EVR UPGRADE <br />F <br />EPA Site # <br />Project Contact & Telephone # Masood Choudhury (909) 620-5962 <br />A <br />C <br />Facility Name Frontier California Inc - Manteca CO <br />Phone # (909) 620-5962 <br />1 <br />Address 430 W. Center Street, Manteca, CA 95336 <br />L <br />I <br />T <br />Cross Street Acacia Avenue <br />Y <br />Owner/Operator Frontier California Inc <br />Phone # (909) 620-5962 <br />C <br />Contractor Name SunWest Engineering Constructors, Inc. <br />Phone # (888) 588-8737 <br />0 <br />N <br />T <br />Contractor Address 4780 Cheyenne Way, Chino, CA 91710 <br />CA Lic # 703190 Class A, B, Haz <br />R <br />Insurer State Compensation Insurance Fund of CA <br />Work Comp # 9243819-22 <br />A <br />T <br />T <br />ICC Technician's Name Kraig Kinder <br />Expiration Date 1/22/2024 <br />R <br />ICC Installer's Name Kraig Kinder <br />Expiration Date 1/22/2024 <br />Tank system work area <br />Tank Size <br />Chemicals Stored Currently <br />Date UST <br />(i.e. 87 piping sump, 91 leak detector, UDC 1/2, etc.) <br />Installed <br />T <br />Piping Sump/Fill SumpNault/Fuel Polisher/ <br />6,000 gallon <br />Diesel <br />A <br />N <br />K <br />P <br />❑ Approved ❑ Approved with conditions ❑ Disapproved <br />L <br />(See Attachment 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 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 Date <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 #. <br />4780 Cheyenne Way, Chino, CA 91710 <br />SIGNATUR <br />2 of 6 <br />(909) 536-6458 <br />9/26/2023 <br />