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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 si oyof ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Safeway Stan Olea <br /> FACILITY ADDRESS SITE PHONE*WITH AREA CODE <br /> 6425 N Pacific Ave Stockton CA 95207 209-4 2-8600 <br /> CITY STATE LP CODE 00 TANKS AT SITE <br /> Stockton CA 95207 <br /> 3 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Able Maintenance, Inc <br /> Mart Weithman <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE N WITH AREACODE <br /> 680 Quinn Ave. <br /> 408 213-6038 <br /> CITY STATE ZIP CODE CIRCLE WORK TOE! DONE CONTRACTOR ICC N <br /> San Jose CA 95112 0 <br /> 8022810 <br /> ACTIVE FACILITY <br /> $500 FEE INCLUDES FACILITY FEE+ 1 TANK(2003-2008) 2004 2005 2006 MO8$550 FEE INCLUDES FACILITY FEE+ 1 TANK(2009)$125 PER TANK AFTER FIRST TANK $ <br /> TANK PENALTY ASSESSED $ <br /> TANK SURCHARGE=S15/TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGR $ <br /> PERMANENTCLOSURE <br /> Removal or Permitted Closure in Place <br /> TANKID# s : CLOSUREFEE=$315/TANK #TANKS X$315= $ <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID#(s): TEMPORARY CLOSURE FEE=$315/FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan Check end Construction Inspections) <br /> TANK ID#(a): PLAN CHECK FEE=$840/FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID#(a): <br /> TANK RETROFIT REPAIR FEE =$315/FACILITY (use for monitoring equipment,cold starts,EVR upgrades, $ 375 <br /> s 01 buckets sum s,mise. <br /> PIPING REPAIR FEE _$315/FACILITY use for piping,under-dispenser containment,act.) $ <br /> MISCELLANEOUS <br /> TRANSFER FEE - 20 $ <br /> CONSULTATION FEE = S 105/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $ 105/HOUR $ <br /> SAMPLING INSPECTION FEE = S 1051 HOUR $ <br /> ALL FEES ARE BASED ON THE 5105 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST I FACILrrY ID IAMOUNT RECEIVED CHECK N 0.ECENEO 6Y DATE RECEIVED <br /> SR <br /> EM 7$037(REVISED 0=3109) <br />