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SAN JOAQUIN EnvironmentaR�t/DlEt�r�er�ED <br /> COUN TY L„�, �� �' �V �� <br /> APPLICATION FOR UNDERGROUND STORAGE TANK SEP 1 12025 <br /> RETROFIT OR PIPING REPAIR PERMIT ENVIRONMENTAL HEALTH <br /> THIS PERMIT EXPIRES 180 DAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE BELOWERMIT/SERVICES <br /> ❑ TANK RETROFIT ❑ PIPING REPAIR/RETROFIT ❑ UDC REPAIR/RETROFIT ❑ COLD START/EVR UPGRADE <br /> F EPA Site # Project Contact & Telephone # <br /> A <br /> C Facility Name Elite Fuels Phone #510-362-1799 <br /> I Y ,Address 2375 N.Trac Blvd. Tracy,Y, CA 95376 <br /> TCross Street Grant Line Rd <br /> Y Owner/OperatorAmin Khan Phone #510-362-1799 <br /> c Contractor Name ECO-CHEK Compliance, Inc. Phone #925-499-6294 <br /> O <br /> T Contractor Address P.O. Box 1394., Lafayette, CA 94549 CA Lic # 958763 Class A <br /> A Insurer State Compensation Fund Work Comp # 1942346-24 <br /> T ]CC Technician's Name Marco Alejos Expiration Date 02/28/2027 <br /> ° ICC Installer's Name Expiration Date <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 Waste Oil Waste Oil <br /> A <br /> N <br /> K <br /> P Approved pproved with conditions disapproved <br /> L (S Attachment With Conditions) <br /> A ,fin <br /> N 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, 1 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 HICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS <br /> OF CALIFORNIA." <br /> Applicant's Signature Title Office/Business Affairs Manag(Date 09/11 /2025 <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 Cadacio-Chats TITLE Office/Business Affairs Manager PHONE # 925-499-6294 <br /> ADDRESS P.O. Box 1394. , Lafayette, CA 94549 <br /> SIGNATURE DATE 9/1 1 /2025 <br /> 2of6 <br />