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SAN JOAQUIN EnvironmentREGE D <br /> .___COUNTY <br /> O C T 0 8 2025 <br /> APPLICATION FOR UNDERGROUND STORAGE TANK <br /> RETROFIT OR PIPING REPAIR PERMIT ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> THIS PERMIT EXPIRES 180 DAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE BELOW: <br /> ❑TANK RETROFIT ❑PIPING REPAIR/RETROFIT ❑UDC REPAIRIRETROFIT ❑COLD START/EVR UPGRADE <br /> F EPA Site# Project Contact&Telephone#Toya Chapagain-669-500-3476 <br /> A <br /> Facility Name Fast& Easy#60 Phone#707-486-8894 <br /> L Address 10878 N Hwy 99., Stockton, CA 95212 <br /> T Cross Street Eight Mile Rd <br /> Y Owner/Operator Mike Ali Phone#209-931-6154 <br /> o Contractor Name Eco-Chek Compliance, Inc Phone#925-499-6294 <br /> N Contractor Address P.O. Box 1394 CA Lic# <br /> T 958763 Class A <br /> A Insurer State Compensation Fund Work Comp#1942346-24 <br /> T ICC Technician's Name Marco Alejos Expiration Date 02/28/27 <br /> R ICC Installer's Name Marco Alejos Expiration Date 02/28/27 <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 <br /> A <br /> N <br /> K <br /> P Approved pproved with conditions [jisapproved <br /> L A e Attachment With Conditions) r <br /> N Plan Reviewers Name Date <br /> APPLICANT MUST PERFORM ALL WORK IN ACCOR E 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 FO THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS <br /> OF CALIFORNIA." <br /> Office/Business Affairs Manager 10/08/2025 <br /> Applicant's Signature ;Z 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 Cindy Cadaclo-Chan TITLE Office/Business Affairs Manager PHONE#925-499-694 <br /> ADDRESS P.O. Box 1394., Lafayette, CA 94549 <br /> SIGNATURE ' DATE 1 0/08/2025 <br /> 2 of 6 <br />