Laserfiche WebLink
SANJOAQUIN Environmental Health Department <br /> COUNTY <br /> — <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 /> ❑TANK RETROFIT ❑PIPING REPAIR/RETROFIT OUDC REPAIR/RETROFIT ❑COLD START/EVR UPGRADE <br /> F EPA Site# Project Contact&Telephone#925-499-6294 <br /> A <br /> O Facility Name Xpress Gas&Mart Inc Phone#510-378-2992 <br /> L <br /> Address3440 E Main St. Stockton, CA 95208 <br /> TCross Street South Broadway <br /> Y Owner/OperatorZia Omar Phone#510-378-2992 <br /> c Contractor Name Eco-Chek Compliance, Inc Phone#925-499-6294 <br /> 0 <br /> N T Contractor Address 3100 Oak Rd#205 CA Lie# 958763 Class A <br /> AInsurer State Compensation Insurance Fund Work Comp#1942346-25 <br /> T T Expiration]CC Technician's Name Marco Ale1 p�ration Date 2/28/27 <br /> R ICC Installer's Name Marco Alejos Expiration Date 11/10/27 <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 UDC 1-2 87, 91, Diesel <br /> A UDC 5-6 87, 91, Diesel <br /> N <br /> K <br /> P aApproved Approved with conditions disapproved <br /> L (See Attachment With Conditions) <br /> A <br /> N Plan Reviewers Name C a Vb 1 Ares t7C:) Date 12.4, <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 <br /> Business Affairs/Office Manager Date 3/27/2026 <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 Business Affairs/Office Manager PHONE#925-499-6294 <br /> ADDRESS 3100 Oak Rd., Suite 205., Walnut Creek, CA 94597 <br /> SIGNATURE ——ti DATE 3/27/2026 <br /> 2of6 <br />