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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMEI�I <br />304 ast Weber Avenue, 3`d Floor, Stockton, CA 95201.-2708 <br />Telephone: (209) 468-3420 Fax (5`" floor): (209) 468-3433 Web: www.slgov.or /g ehd <br />FACILITY NAME <br />FACILITY CONTACT NAME <br />ConocoPhillips 2611194 <br />Eric Janzen <br />FACILITY ADDRESS <br />SITE PHONE # WITH AREA CODE <br />2375 Tracy Blvd. <br />(707) 789-3255 Ext. 18 <br />CITY <br />STATE <br />ZIP CODE <br /># OF TANKS AT SITE <br />Tracy <br />CA <br />CA <br />94954 <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />Gettler-Ryan Inc. <br />Eric Janzen <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />1364 N. McDowell Blvd. Suite B2 <br />(707) 789-3255 Ext. 18 <br />CITY <br />STATE <br />ZIP CODE <br />CIRCLE WORK TO BE DONE <br />CONTRACTOR ICC # <br />Petaluma <br />CA <br />94954 <br />Closure Installation Repair Retrofit <br />$125 PER TANK AFTER FIRST TANK <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 _ $ 93/ 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 />INSTALLATION PLAN CHECK <br />(Plan Check and Construction Ir <br />TANK ID # (s) : <br />REPAIR PLAN CHECK <br />TANK ID # (s). 2611194 WO <br />PLAN CHECK FEE = $744 / FACILITY <br />TANK RETROFIT REPAIR FEE = $279 / FACILITY (use for monitoring equipment, spill buckets, tank sumps, misc. <br />PIPING REPAIR FEE = $279 / FACILITY (use for piping, under -dispenser containment, ect.) <br />MISCELLANEOUS <br />ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br />SR <br />TRANSFER FEE _ $ 20 <br />CONSULTATION FEE _ $ 93/ HOUR <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR <br />SAMPLING INSPECTION FEE _ $ 93/ HOUR <br />ALL FCtS AKt bAStU UN I Kt X93 HUUKLT KAI t. I IMt 1 r1A I rm mr-Ua rCCa rAIIJ YYILL OG o11LCY 1 V nrr LlvMl\ 1. <br />ncclrc I Icc nn1) v <br />SERVICE REQUEST #FACILITY <br />ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br />SR <br />LN Z3 UJZ (KtVIStU UZ/ZZI1.00) <br />