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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov" r /ehd <br />FACILITY NAME FACILITY CONTACT NAME <br />Chevron Tony Quijalvo <br />FACILITY ADDRESS SITE PHONE # WITH AREA CODE <br />10858 Trinity Parkway, Stockton CA 95219 (209-912-2213 <br />CITY STATE ZIP CODE # OF <br />Stockton CA 95219 <br />3 <br />Service Station Systems, Inc. <br />Marty Weithman <br />APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br />680 Quinn Ave. <br />408 213-6038 <br />CITY STATE -7 ZIP CODE CIRCLE WORK TO BE DONE CONTRACTO <br />San Jose CA 95E���]112 0 <br />0 5261142 -UT <br />ACTIVE FACILITY <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK (2003-2008) 2004 2005 2006 2007 2008 2009 <br />$550 FEE INCLUDES FACILITY FEE + 1 TANK (2009) <br />$125 PER TANK AFTER FIRST TANK $ <br />TANK PENALTY ASSESSED $ <br />TANK SURCHARGE = $15 / TANK $ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =cJe nnr cnrit jr. $ <br />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # s CLOSURE FEE = $315 /TANK # TANKS X $315 = <br />TEMPORARY CLOSURE <br />Pian Review and inspections) <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = $315 / FACILITY <br />INSTALLATION PLAN CHECK <br />(Plan Check and Construction Ir <br />CHECK FEE = $840 / FACILITY <br />REPAIR PLAN CHECK <br />TANK ID # (s) : <br />TANK RETROFIT REPAIR FEE = $315 / FACILITY (use for monitoring equipment, cold <br />s ill buckets ,sunmers<, msiscn. <br />sercontstarts, EVR upgrades, <br />PIPING REPAIR FEE = $315 / FACILITY mai <br />$ <br />366 <br />$ <br />FFICE USE ONLY <br />ERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK # RECENED l3Y DATE RECEIVED <br />R <br />123 032 (REVISED 02123709) <br />