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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 Easl Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.si'gov.org/ehd FACILITY NAME FACILITY CONTACT NAME Chevron Pauline FACILITY ADDRESS SITE PHONE # WITH AREA CODE 10858 Trinity Parkway, 209-92-2213 CITY STATE ZIP CODE # OF TANKS AT SITE Stockton 95219 CA 3 APPLICANT BILLING NAME APPLICANT CONTACT NAME Service Station Systems, Inc. Marty Weithman PPLICANT MAILING ADDRESS APPLICANT PHONE #WITH AREA CODE 680 Quinn Ave. 408 213-6038 ITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRAi San Jose CA 95112 0 0 5258560 ACTIVE FACILITY $500 FEE INCLUDES FACILITY FEE + 1 TANK (2003-2008) $550 FEE INCLUDES FACILITY FEE + 1 TANK (2009) $125 PER TANK AFTER FIRST TANK 2004 20 05 2006 20 07 2008 2009 TANK PENALTY ASSESSED TANK SURCHARGE = $15 / TANK STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY INA CUPA PROGRAM =$24.00/ FACILITY PERMANENT CLOSURE Removal or Permitted Closure in Place TANK ID # s CLOSURE FEE _ $315 / TANK # TANKS X $315 = TEMPORARY CLOSURE Plan Review and Inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $315 / FACILITY INSTALLATION (Plan Check and ICC # TANK ID # (s) : I PLAN CHECK FEE = $840 / FACILITY 1 $ REPAIR PLAN CHECK TANK lb -# (s) : TANK RETROFIT REPAIR FEE = $315 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, s ill buckets, sum s, misc. PIPING REPAIR FEE = $315 / FACILITY use for pi ing, under -dispenser containment, ect. MISCELLANEOUS TRANSFER FEE _ $ 20 CONSULTATION FEE _ $ 105/ HOUR UNAUTHORIZED RELEASE EVALUATION FEE = $ 105 / HOUR SAMPLING INSPECTION FEE _ $ 105/ HOUR ALL FEES ARE BASED ON THE =105 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WIL—L--IB—E---B I--L–L --ED TO APPLICANT. 375 $ )FFIGE USE ONLY ERVICE REQUEST# FACILITY ID I AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED .R H 23 032 (REVISED 02/23/09)