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❑ New Facility ® Existing Facility San Joaquin County Environmental Health Department Application Form Facility Name FedEx Ground - Trac Site Address City State ZIP 5655 Hood Wav Tracy CA 95377 APN Supervisor District ZIP 38120 Phone Phone Email Type of Service ❑ Application for ❑ Consultation ❑ Change of Owner M Repairs or Remodel ❑ Other Requested Operating Permit Albert. barajas@jfpetrogrou p. Comments Replace flex connector in T1 and T2 Diesel STP sump. If mobile food truck or License Plate Number VIN pumper truck Contact Types ❑ Billing Party ❑ Facility Owner ❑ Facility Contact IN Property Owner X Contractor ❑ Architect required ❑ Billing Party ❑ Facility Owner ❑ Facility Contact I%I Property Owner ❑ Contractor -T ❑ Architect First Name FedEx Freight, Inc Last name If contractor, indicate type and license number Address 942 S. Shad Grove Rd Y City Memphis State TN ZIP 38120 Phone Phone Email Phone Phone Email ❑ Billing Party ❑ Facility Owner ❑ Facility Contact ❑ Property Owner I[A Contractor ❑ Architect First Name Albert Last name Barajas If contractor, indicate type and license number Address City 804431 Address 9595 Lucas Ranch Road #100 City Rancho Cucamonga State CA ZIP 91730 Phone Phone Email 909 213-5266 Albert. barajas@jfpetrogrou p. ❑ Billing Party ❑ Facility Owner ❑ Facility Contact ❑ Property Owner ❑ Contractor ❑ Architect First Name Last name If contractor, indicate type and license number Address City State ZIP Phone Phone Email BILLING ACKNOWLEDGEMENT: I, the undersigned property or business owner, operator or authorized agent of same, acknowledge that all site and/or project specific ENVIRONMENTAL HEALTH DEPARTMENT hourly charges associated with this project or activity will be billed to me or my business as identified on this form. I also certify that I have prepared this application and that the work to be performed will be done in accordance with all SAN JOAQUIN COUNTY Ordinance Codes, Standards, STATE and FEDERAL laws. APPLICANT'S SIGNATURE: DATE: 07/25/25 u�— ❑ PROPERTY/ BUSINESS OWNER ❑ OPERATOR/ MANAGER ❑ OTHER AUTHORIZED AGENT® Assistant Environmental Compliance PM Title If APPLICANT is not the BILLING PARTY, proof of authorization to sign is required AUTHORIZATION TO RELEASE INFORMATION: When applicable, I, the owner or operator of the property located at the above site address, hereby authorize the release of any and all results, geotechnical data and/or environmental/site assessment information to the SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT as soon as it is available and at the same time it is provided to me or my representative. Accepted By Assigned To Linked FA ID Date PE Fee Record Number Payment ElCash El check # 71 Confirmation # Received By Rev 07/10/2024