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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street;Stockton,CA 95202.3029 <br /> Telephone:(209)46&3420 Fax•(209)468-3433 Web:www sjgov or&/ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Chevron manager <br /> FACILITY ADDRESS SITE PHONE 1I WIT#t AREA CODE <br /> 4344 Waterloo Rd (209-911 2186 <br /> QTY I STATE ZIP CODE #OF TANKS AT SITE <br /> Stockton CA 95215 <br /> 3 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Service Station Systems, Inc. Marty Weithman <br /> APPLICANT MAILING ADDRESS APPLICANT RHONE#WITH AREA CODE <br /> 680 Quinn Ave. <br /> 408 213-6038 <br /> CITY �ECA <br /> E ZIP CODE CIRCLE K TO 6E DONE CONTRACTOR ICC S <br /> San Jose 95112 <br /> jf Q 5258558-UT <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+1 TANK(2009) <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 COPA PROGRAM=$24.00/FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID# s : CLOSURE FEE= 315/TANK #TANKS X 5315= $ <br /> TEMPORARY CLOSURE <br /> (Plan Review and Inspections) <br /> TANK ID#(s): TEMPORARY CLOSURE FEE_$315/FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Pian Check and Construction Inspections) <br /> TANK iD#(s): 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 /> s 111 buckets sum misc. 345 <br /> PIPING REPAIR FEE _$315/FACILITY use for pift,under-dispenser containment,ec;L $ <br /> MISCELLANEOUS <br /> TRANSFER FEE = 20 $ <br /> CONSULTATION FEE = $105/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $105/HOUR $ <br /> SAMPLING INSPECTION FEE _ $1051 HOUR $ <br /> ALL FEES ARE BASED ON THE$105 HOURLY RATE.TIME THAT EXCEEDS FEES PAID WILL BE BPLLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQ EST# FACILITY ID AMOUNT RECENED CHECK# RECENED BY DATE RECEIVED <br /> ISR <br /> EH 23 esz ROME esnuo:t) <br />