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SAN0 A QU i Environmental Health Department <br />COUNTY— <br />APPLICATION <br />OUNTAPPLICATION 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 ❑ UDC REPAIR/RETROFIT ❑ COLD START/EVR UPGRADE <br />F <br />EPA Site # <br />Project Contact & Telephone # <br />A <br />C <br />Facility Name Vanco Truck & Auto <br />Phone # 916-396-1665 <br />1 <br />L <br />Address 1033 W. Charter Way, Stockton <br />I <br />Cross Street <br />T <br />Y <br />Owner/Operator Mike Boparai <br />Phone # 916-396-1665 <br />C <br />Contractor Name ECO-CHEK Compliance, Inc. <br />Phone # 925-499-6294 <br />T <br />Contractor Address P.O. Box 1394, Lafayette, CA 94549 <br />CA Lic # 958763 Class A <br />R <br />A <br />Insurer <br />Work Comp # <br />T <br />T <br />ICC Technician's Name Zane Nimmo <br />Expiration Date 8883064 <br />Q <br />R <br />ICC Installer's Name Zane Nimmo <br />Expiration Date <br />P <br />Tank system work area <br />Tank Size <br />Chemicals Stored Currently <br />Date UST <br />(i.e. 87 piping sump, 91 leak detector, UDC 1/2, etc.) <br />Installed <br />T <br />A <br />N <br />K <br />P <br />❑ Approved ❑ Approved with conditions ❑ Disapproved <br />L <br />(See Attachment With Conditions) <br />A <br />N <br />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, 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 CH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S COMPENSATION LAWS <br />~ <br />OF CALIFORNIA." <br />Applicant's Sig natur � Title Compliance Operations Associate Date 6/21/2024 <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-Chan TITLE Compliance Operations Associate PHONE # 925-499-6294 <br />ADDRESS P.O. UUA I JJY., La' IOYGIIG, l'/l JYJYJ <br />SIGNATU <br />2 of 6 <br />TE 6/21/2024 <br />