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S A N JOAQUIN <br /> OA 4 I I I N Environmental Health Department <br /> COUNTY I! <br /> APPLICATION FOR UNDERGROUND STORAGE TANK INSTALLATION PERMIT <br /> THE APPLICATION FOR INSTALLATION OF UNDERGROUND STORAGE TANKS IS ONLY VALID FOR THE CALENDAR YEAR IN WHICH IT HAS BEEN <br /> ISSUED. A PERMIT MAY BE EXTENDED INTO THE NEXT CALENDAR YEAR IF A LETTER IS SENT TO EHD REQUESTING THIS EXTENSION THIRTY <br /> DAYS PRIOR TO THE END OF THE CALENDAR YEAR. A ONE TIME, ONE YEAR EXTENSION MAY BE GRANTED BY EHD UPON RECEIPT OF THIS <br /> LETTER. <br /> PROJECT CONTACT: CONTACT PHONE# <br /> Pardip Singh <br /> 209-992-9253 <br /> FACILITY NAME: FACILITY PHONE# <br /> OEM Petroleum, LLC 925-446-6806 <br /> FACILITY ADDRESS: CROSS STREET: <br /> 2910 Eight Mile Rd. Stockton, CA 95209 Thorton Rd <br /> OWNER/OPERATOR: PHONE: <br /> CJ Dhaliwal 925-446-0102 <br /> CONTRACTOR NAME: PHONE: <br /> Town & Country Contractors, Inc. 916-636-9500 <br /> CONTRACTOR ADDRESS: CA LICENSE# <br /> 3206 Luyung Dr. RANCHO CORDOVA, CA 95742 238112 <br /> HAZARDOUS WASTE CERTIFICATE: WORKERS COMP# <br /> 238112 haz X YES NO 1001714985 <br /> FIRE DISTRICT: Stockton Fire Dept. PERMIT# 18-04929 <br /> TANK ID# TANK SIZE CHEMICAL STORED PROPOSED INSTALL DATE <br /> 1 25 000 al 87 Gasoline August 2023 <br /> 2 12 000 al 91 Gasoline ---August <br /> 10 000 al Diesel August 2023 <br /> ❑APPROVED ❑APPROVED WITH CONDITIONS ❑ DISAPPROVED <br /> (see attachments) <br /> PLAN REVIEWER'S NAME DATE <br /> APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS,RULES AND <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT. OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE <br /> FOLLOWING"I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.,I SHALL NOT EMPLOY <br /> ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA." <br /> CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING "I CERTIFY THAT IN THE <br /> PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br /> COMPENSATION LAWS OF CALIFORNIA." <br /> Applicant's Signature Pardip Singh D' o <br /> Na"yasena...l'o a'""' <br /> E=D.sinq 5QnorcaloRice.com.CN=P—N S..9h <br /> Title Director of Develnnment Date 8/14/23 <br /> Indicate the responsible party to be billed for additional EHD staff time expended beyond the 8-hour minimum installation <br /> payment.The party must acknowledge this responsibility for the additional billing by signature and date below. <br /> Name OEM Petroleum, LLC Date 8/14/23 <br /> Mailing Address 2190 Meridian Park Blvd. Ste. G Concord, CA 94520 <br /> Signature Pardip Singh Daytime Phone 925-446-6806 <br /> 3of8 <br />