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SAN JOAQUIN COUNTY is <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:&MM d ov.or ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Tracy Blvd Shell&Mini Mart Joe Haithcoat <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 3725 N Tracy Blvd,Tracy CA 95376 (209-815-7608 <br /> CITY STATE ZIP CODE. #OF TANKS AT SITE <br /> Tracy CA 95376 <br /> 4 <br /> APPLICANT BILLING NAME -, APPUCANTL;VNJAf;jNME <br /> Service Station Systems, Inc. <br /> Marty Weithman <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 680 Quinn Ave. <br /> 408 213-6038 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> San Jose CA 95112 <br /> 0 8001468-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 CUPA PROGRAM= 2=4.0D1FACIL1=TY :E <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Pince <br /> TANK ID#Ls): CLOSURE FEE=$315/TANK #TANKS X$315= $ <br /> TEMPORARY CLOSURE <br /> Plan Review and,lns clions <br /> TANK ID#(s): TEMPORARY CLOSURE FEE_$315/FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> TANK ID#(s): PLAN CHECK FEE_$8401 FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID#(s). <br /> TANK RETROFIT REPAIR FEE _$315 l FACILITY (use for monitoring equipment,cold starts,EVR upgrades, $ 345 <br /> s ill buckets sum misc. <br /> PIPING REPAIR FEE _$315/FACILITY use for ,under-dispenser containment,ect $ <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. TMAE THAT EXCEEDS FEES PAID%MLL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST* FACILITY!DI AMOUNT RECEtVEO I CHECK 0 RECEIVED BY DATE RECEIVED <br /> SR <br /> EH 23 032(REVISED O ) <br />