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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 Far:(209)468-3433 Web:www.s' ov. r ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Safeway Elanor Bitton <br /> FACILITY ADDRESS SITE PHONEM WIT#1 AREA CODE <br /> 6425 N. Pacific Ave, Stockton CA 95207 209-4 2-8600 <br /> CITY STATE LP CODE #OF TANKS AT SITE <br /> Stockton CA 95207 <br /> 3 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Able Maintenance, Inc Mart Weithman <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 680 Quinn Ave. <br /> 408 213-6038 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> San Jose CA 95112 <br /> 0 5252033-U1 <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 i 1 TANK(2008) <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=$24.00/FACILITY $ <br /> PERMANENT CLOSURE <br /> RemOVel or Permitted Closure in Place <br /> TANK ID#(a): CLOSURE FEE=$315/TANK It TANKS X$315= $ <br /> TEMPORARY CLOSURE <br /> Plan Review and Ins Cions <br /> TANK ID#(e): TEMPORARY CLOSURE FEE_$3151 FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan (and Construction Inspections) <br /> TANK ID#(a); PLAN CHECK FEE_$840/FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <br /> TANK RETROFIT REPAIR FEE =$315/FACILITY (use for monitoring equipment,cold starts.EVR upgrades, $ <br /> ill buckets sum misc. 345 <br /> PIPING REPAIR FEE _$315/FACILITY use for i in ,underdls ser mnlainmenl,act.) $ <br /> MISCELLANEOUS <br /> TRANSFER FEE = 20 $ <br /> CONSULTATION FEE = S 105/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $105/HOUR $ <br /> SAMPLING INSPECTION FEE _ $'or,-HO <br /> UR $ <br /> ALL FEES ARE BASED ON THE 3105 HOURLY RATE. TMAE THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT, <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECENED CHECK N RECENED BY DATE RECENED <br /> SR <br /> EH 23 032(REVISED 02R3I09) <br />