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19255517888 Main Fax GETTLER RYAN INC 3:31 P.M. 01-11-2007 3/11 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 East Weber Avenue, 3 Floor, Stockton, CA 95202-2708 Telephone: (209) 468-3420 Fax (5hfloor): (209) 468-3433 Web: www.sigov.org/ehd FACILITY NAME APPLICANT CONTACT NAME FACILITY CONTACT NAME ARCO APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE FACILITY ADDRESS 925 551.7555 SITE PHONE # WITH AREA CODE 3425 TRACY BLVD 925 1 551-7555 CITY Dublin I STATE ZIP CODE # OF TANKS AT SITE TRACY $125 PER TANK AFTER FIRST TANK I CA 95376 APPLICANT BILLING NAME APPLICANT CONTACT NAME Gettler Ryan Inc. LIDDY MCKENZIE APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE 6747 Sierra Court, Suite J 925 551.7555 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # Dublin CA 94568 Closure Installation Repair Retrofit 5250451-u1 ACTIVE FACILITY TANK ID # s CLOSURE FEE _ $2791 TANK 2000 2001 2002 2003 2004 2005 $500 FEE INCLUDES FACILITY FEE + 1 TANK $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR $ SAMPLING INSPECTION FEE _ $ 93/ HOUR $125 PER TANK AFTER FIRST TANK TANK PENALTY ASSESSED TANK SURCHARGE= $15 /TANK $ STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A COPA PROGRAM =$24.00/ FACILITY PERMANENT CLOSURE Removal or Permitted Closure in Place TANK ID # s CLOSURE FEE _ $2791 TANK # TANKS X $279 = TEMPORARY CLOSURE Plan Review and Inspections) TANK tD # (s) : j TEMPORARY CLOSURE FEE = $279 / FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Inspections) TANK ID # (s) : PLAN CHECK FEE = $744 / FACILITY REPAIR PLAN CHECK TANK 10 # (s): $ TANK RETROFIT REPAIR FEE _ $2791 FACILITY (use for monitoringequipment, spill buckets, tank sum s, misc.) $ 285 PIPING REPAIR FEE = $279 / FACILITY use for ing, under -dispenser containment, ed. $ MISCELLANEOUS $ TRANSFER FEE _ $ 20 $ CONSULTATION FEE = $ 931 HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR $ SAMPLING INSPECTION FEE _ $ 93/ HOUR ALL FEES ARE BASED ON THE $93 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. OFFICE USE ONLY SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK 9 RECEIVED BY DATE RECEIVED SR EH 23 032 (REVISED 02f22105)