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SAN JOAQUIN EnvirNfftifivtu <br /> t <br /> COUNTY <br /> APPLICATION FOR UNDERGROUND STORAGE TAW 2 6 2023 <br /> RETROFIT OR PIPING REPAIR PERMIT <br /> ENVIRONMENTAL HEALTH <br /> THIS PERMIT EXPIRES 180 DAYS FROM THE APPROVAL DATE, INDICATE PERMIT TY MK/ SERVICES <br /> N TANK RETROFIT ❑ PIPING REPAIR/RETROFIT ❑ UDC REPAIRIRETROFIT ❑ COLD START/EVR UPGRADE <br /> F EPA Site # Project Contact & Telephone # Masood Choudhury (909) 620-5962 <br /> A <br /> C Facility Name Frontier California Inc - Manteca CO Phone # (909) 620-5962 <br /> I <br /> L Address 430 W. Center Street, Manteca , CA 95336 <br /> TCross Street Acacia Avenue <br /> Y Owner/Operator Frontier California Inc Phone # (909) 620-5962 <br /> C Contractor Name SunWest Engineering Constructors , Inc. Phone # ( 888) 588-8737 <br /> 0 <br /> T Contractor Address 4780 Cheyenne Way, Chino, CA 91710 CA Lie # 703190 Class A, B , Haz <br /> AInsurer State Compensation Insurance Fund of CA Work Comp # 9243819-22 <br /> cICC Technician 's Name Kraig Kinder <br /> T 9 Expiration Date 1 /22/2024 <br /> 0ICC Installer's Name <br /> R Kraig Kinder Expiration Date 1 /22/2024 <br /> Tank system work area Tank Size Chemicals Stored Currently Date UST <br /> (0, 87 piping sump, 91 leak detector, UDC 1 /2, etc.) Installed <br /> Piping Sump/Fill SumpNault/Fuel Polisher/ <br /> T Monitor System 6, 000 gallon Diesel <br /> A <br /> N <br /> K <br /> P ❑ Approved [1a Approved with conditions ❑ Disapproved <br /> L (See Attachment With Conditions) <br /> Ao IIN Plan Reviewers Name 1 Date to � u 13 <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 Project Manager Date 9/26/23 <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 # (909) 536-6458 <br /> ADDRESS 4780 Cheyenne Way, Chino , CA 91710 <br /> SIGNATURE DATE 9/26/2023 <br /> 2of6 <br />