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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd FACILITY NAME FACILITY CONTACT NAME F W Y FUEL CENTER #2600 STAN OLEA FACILITY ADDRESS SITE PHONE # WITH AREA CODE 1801 WEST 11th STREET �-0.3 8 3C� 2c� S p CITY I STATE ZIP CODE # OF TANKS AT SITE TRACY CA 95376 3 APPLICANT BILLING NAME APPLICANT CONTACT NAME LHB & ASSOCIATES JEFFREY LEE APPLICANT MAILING ADDRESS 586 HIGUERA STREET, SUITE 200 CITY STATE ZIP CODE APPLICANT PHONE # WITH AREA CODE 05 540-5240 CIRCLE WOR�TO E DONE CONTRACTOR ICC #SAN LUIS OBISPO CA 93401 Closure Installatiair etrofit ACTIVE FACILITY 2004 2005 2006 2007 2008 2009 $500 FEE INCLUDES FACILITY FEE + 1 TANK (2003-2008) $550 FEE INCLUDES FACILITY FEE + 1 TANK (2009) $ $125 PER TANK AFTER FIRST TANK TANK PENALTY ASSESSED TANK SURCHARGE = $15 / TANK STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A 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 Plan Check and Construction Inspections) TANK ID # (s) : PLAN CHECK FEE = $840 / FACILITY REPAIR PLAN CHECK TANK ID # (s) : TANK RETROFIT REPAIR FEE = $315 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, spill buckets, sumps, misc. 315.00 PIPING REPAIR FEE _ $315 / FACILITY (use for piping, under -dispenser containment 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 WILL BE BILLED OFFICE USE ONLY SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED SR EH 23 032 (REVISED 02/23/09)