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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENO <br /> 600 East Main Street,Stockton"CA 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.si2ov.orp-/ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> SB GAS & MARKET SANJAY BIRLA <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 515 W. 11TH STREET 10-?66-9924 <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> TRACY CA 95376 2 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> TOWN & COUNTRY CONTRACTORS, INC LUCY SILVAS-THOMAS <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 3181 LUYUNG DRIVE STE A 916 636-9500 <br /> CITY STATE I ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> RANC170 CORDO= CA 195742 Closure Installation Repair Retrofit 5 2 7 5 5 5 7-Ul <br /> EVR UPGRADE <br /> ACTIVE FACILITY <br /> 2003 2004 2005 2006 2007 2008 <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK(2002-2007) <br /> $550 FEE INCLUDES FACILITY FEE+1 TANK(20=08) <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 /> Removal or Permitted Closure in Place <br /> TANK ID#(s): CLOSURE FEE=$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 and Construction Inspections) <br /> TANK ID#(s): PLAN CHECK FEE_$840/FACILITY <br /> REPAIR PLAN CHECK EVR I I UPGRADE <br /> TANK ID#(s): <br /> �A�NKRET�ROFIT� EPAIR�FEE =$315/FACILIT�(use �monito�ringequ�ipment,cold starts,EVR upgrades, 315 <br /> PIPING REPAIR FEE _$315/FACILITY use for piping,under-dispenser containment,ect. <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $20 <br /> CONSULTATION FEE _ $105/HOUR <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $105/HOUR <br /> SAMPLING INSPECTION FEE = $105/HOUR <br /> ALL FEES ARE BASED ON THE$105 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED I CHECK# RECEIVED BY DATE RECEIVED <br /> SR <br /> FH 91 039/RFVIAFf1 71IRinR% --- - <br />