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19255517888 Main Fax GETTLER RYAN INC 10-10 03 a m_ 12-06-2006 6/10 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, P Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax (e floor): (209) 468-3433 Web. www.sigov.or /g ehd <br />FACILITY NAME <br />FACILITY CONTACT NAME <br />Olympian "Flyers" <br />Liddy McKenzie <br />FACILITY ADDRESS <br />SITE PHONE # WITH AREA CODE <br />983 <br />Moffat Blvd 925 1 551-7555 <br />CITY <br />I STATE I ZIP CODE <br />I # OF TANKS AT SITE <br />Manteca <br />I CA <br />94568 <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />Gettler Ryan Inc. <br />Liddy McKenzie <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />6747 Sierra Court, Suite J <br />19251551-7555 <br />CITY STATE <br />I ZIP CODE <br />CIRCLE WORK TO BE DONE <br />CONTRACTOR ICC # <br />Dublin CA <br />94568 <br />Closure installation Repair Retrofit <br />5250447-u1 <br />ACTIVE FACILITY <br />TANK ID # (s): <br />CLOSURE FEE = $279 / TANK <br />2000 <br />2001 <br />2002 <br />2003 <br />2004 <br />2005 <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR <br />SAMPLING INSPECTION FEE = $ 931 HOUR <br />$125 PER TANK AFTER FIRST TANK <br />$ <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): <br />CLOSURE FEE = $279 / TANK <br /># TANKS X $279 = <br />TEMPORARY CLOSURE <br />Plan Review and Inspections) <br />TANK ID # (s) . <br />TEMPORARY CLOSURE FEE = $279 / FACILITY <br />INSTALLA <br />TANK ID # <br />PLAN CHECK FEE = $744 / FACILITY <br />REPAIR PLAN CHECK <br />TANK ID # (s): <br />TANK RETROFIT REPAIR FEE = $279 / FACILITY (use for monitoring equipment, s ill buckets, tank sumps, misc.) <br />$Z V 5 <br />PIPING REPAIR FEE _ $279 / FACILITY use for piping, under -dispenser containment, ect.) <br />CONSULTATION FEE = $ 93/ HOUR <br />MISCELLANEOUS <br />TRANSFER FEE _ $ 20 <br />CONSULTATION FEE = $ 93/ HOUR <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR <br />SAMPLING INSPECTION FEE = $ 931 HOUR <br />ALL FEES ARE BASED ON THE $93 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br />USE ONLY <br />SR <br />EH 23 032 (REVISED <br />