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May 1214 09:16a Reliable Petroleum 2098458953 P.6 <br />0 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTN4ENT RECEIVED <br />1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br />Telephone. (209) 468-3420 Fax: (209) 468-3433 Web: 3Lw& <br />:.sjpehd,corn MAY 13 2014 <br />\1 D 5-P- M -7 <br />AGILITY ADDRESS <br />1-' 00 <br />sij siiu,ii6Lr <br />SITE PHONE# WITH AREA CODE <br />STATE ZIP CODE <br />CA 1? 5- 3 Cr <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />ge'110'bi-e se-�V.Lies 3�- <br />gooert- baynharf- <br />APPLICANT MAILING ADDRESS I <br />APPLICANT PHONE #VATH AREA CODE <br />lRa>o f6rye 5ko-c-gA <br />2011 <br />ooq ) 0Y — 933 (0 <br />CITY STATE <br />I ZIP CODE <br />CIRCLE WORK TO BE DONE <br />CONTRACTOR ICC O <br />Closure Installation Repair RetrofitT='2 <br />-1L <br />ACTIVE FACILITY <br />1 <br />CLOSURE FEE =$375,'TANK <br />� * TANKS X$375= <br />2008 <br />2099 <br />2010 <br />2011 <br />, 2012 <br />$500 FEE INCLUDES FACILITY FEE + I TANK (2007-20118)2007 <br />$650 FEE INCLUDES FACILITY FEE + 1 TANK {2069-2012) <br />$ <br />$125 PER TANK AFTER FIRST TANK <br />$ <br />TANK PENALTY ASSESSED <br />$ <br />TANK SURCHARGE = S1 5 / TANK <br />$ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CLIPA PROGRAM -$49.00/ FACILITY <br />PERMANENT CLOSURE <br />(Removal or Permitted Closure in Place) <br />TANK ID * (s): <br />CLOSURE FEE =$375,'TANK <br />� * TANKS X$375= <br />TEMPORARY CLOSURE <br />(Plan Review and Inspections) <br />TEMPORARY <br />CLOSURE FEE = $375,1 FACILITY <br />REPAIR PLAN CHECK <br />TANK ID # (5) ; <br />TANK RETROFIT REPAIR FEE = $3751 FACILITY (use for monitoring equipment. cold starts. EVR upgrades, <br />spijj buckets, sumps, misc.) ��� <br />PIPING REPAIR FEE = S3751 FACILITY use for piping, under -dispenser containment, ect.) <br />MISCELLANEOUS <br />TRANSFER FEE $25 <br />$ <br />CONSULTATION FEE = S 1251 HOUR <br />$ <br />UNAUTHORIZED RELEASE EVALUATION FEE = $1251 HOUR <br />$ <br />SAMPLING INSPECTION FEE = $ 125/ HOUR <br />$ <br />Pw.1 rcnzi mr%c xx^acwVm 1r= WI AM MUUMLT ICA I M. I Mr. I t1A A 1'A4;=I-IJ5 f*=b FAIU VVILLM ZILLftU IV ArKLIVAN4, <br />TOTAL AMOUNT DUE 1 $ <br />