COMPLIANCE INFO_2025 - Laserfiche WebLink

Home Browse Search

❑ New Facility ® Existing Facility San Joaquin County Environmental Health Department Application Form Facility Name Flying J 618 Site Address City State ZIP 1501 N Jack Tone Rd Ripon CA 95366 APN Supervisor District Type of Service ❑Application for ❑Consultation ❑Change of Owner X Repairs or Remodel ❑Other Requested Operating Permit Comments As-Built 02/13/25,02/25/25,03/05/25,03/17/25,03/18/25,03/19/25.Replaced(7)leaking flex connectors located in Bio Shed Transition Sump, (6)leaking flex connectors in the S.Diesel Transition Sump(1-10),and(1)leaking flex connectors in the N.Diesel Transition Sump(1-8). If mobile food truck or License Plate Number VIN pumper truck Contact Types ❑Billing Party ❑Facility Owner ❑Facility Contact X Property Owner X Contractor ❑Architect required ❑Billing Party ❑Facility Owner ❑Facility Contact IN Property Owner ❑Contractor ❑Architect First Name Pilot Travel Centers LLC Last name If contractor,indicate type and license number Address 5508 Lonas Drive City State ZIP Knoxville TN 37909 Phone Phone Email ❑Billing Party ❑Facility Owner ❑Facility Contact ❑Property Owner IX Contractor ❑Architect First Name Albert Last name Barajas 1804431 f contractor,indicate type and license number Address City IP 9595 Lucas Ranch Road #100 Rancho Cucamonga sCtA 91730 Phone Phone Email 909 213-5266 Albert.barajas@jfpetrogroup �com ❑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: 04/08/25 ❑PROPERTY/BUSINESS OWNER ❑OPERATOR/MANAGER ❑OTHER AUTHORIZED AGENTDJ 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# El Confirmation# Received By Rev 07/10/2024