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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,ICA 95202-3029 <br /> Telephone:(209)468-3420 Fax;(209)468-3433 Webs 20W.sjgay. r ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Chevron manager <br /> FACILITY ADDRESS SITE PHONE 4l WITH ARE,4 CODE <br /> 3355 Hammer Lane,Stockton CA 95212 1122±17-3699 <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> Stockton CA 95212 <br /> 3 <br /> APPLICANT SILLING"NAME APPLICANT CONTACT NAME <br /> Service Station Systems, Inc. <br /> Martv Weithman <br /> APPLICANT MAILING WDRESS APPLICANT PHONE#WITH AREA CODE <br /> 680 Quinn Ave. <br /> 408 213-6038 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR BCC# <br /> San Jose CA 95112 <br /> 5258558-UT <br /> ACTIVE FACILITY <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK(2003-2008) 2004 2005 2006 2007 200$ 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 CUPA PROGRAM=$24.0<f/FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Piace <br /> TANK ID#(s): CLOSURE FEE= 315/TANK #TANKS X$315= $ <br /> TEMPORARY CLOSURE <br /> Plan Review and Ins coons <br /> TANK ID#(s): TEMPORARY CLOSURE FEE_$315/FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> TANK 10#(s): PLAN CHECK FEE=$640/FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID#(a): <br /> TANK RETROFIT REPAIR FEE =$315/FACILITY (use for monitoring equipment,cold starts,EVR upgrades, $ 345 <br /> .-fit buckets sum misc. <br /> PIPING REPAIR FEE =$315/FACILITY use for ,under-dispenser containment,es.L. <br /> MISCELLANEOUS <br /> TRANSFER FEE = 20 $ <br /> CONSULTATION FEE = $105/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $105 t HOUR $ <br /> SAMPLING INSPECTION FEE = $105/HOUR $ <br /> ALL FEES ARE BASED WON $105 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLK ANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED ECK f RECEIVED BY DATE RECEIVED <br /> SR <br /> EH 23 032(REVISED 0=3/09) <br />