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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.si o� v.or FACILITY NAME FACILITY CONTACT NAME ARCO 5450 Gettler Ryan Inc. FACILITY ADDRESS SITE PHONE # WITH AREA CODE 3425 TRACY BLVD 925 551R50...— 51 5CITY CITY STOCKTON STATE CA ZIP CODE 7N f TANKS AT SITE 95203 111 VEn APPLICANT BILLING NAME APPLICANT CONTACT E 12 CLOSURE FEE = $315 / TANK Gettler Ryan Inc. LIDDY MC ENZIE 2006 APPLICANT MAILING ADDRESS APPLICANT P CODE 6805 Sierra Court, Suite G 925 551-755 T � ? CITY STATE I ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # Dublin CA 94568 Closure Installation (RiRlrRetrofit ACTIVE FACILITY TANK ID # (s): CLOSURE FEE = $315 / TANK 2004 2005 2006 2007 2008 2009 $500 FEE INCLUDES FACILITY FEE + 1 TANK (2004-2007) PIPING REPAIR FEE = $315 / FACILITY (use for piping, under -dispenser containment, ect.) UNAUTHORIZED RELEASE EVALUATION FEE = $ 105 / HOUR $ SAMPLING INSPECTION FEE _ $ 105/ HOUR $550 FEE INCLUDES FACILITY FEE + 1 TANK (2008-2009) $125 PER TANK AFTER FIRST TANK $ TANK PENALTY ASSESSED TANK SURCHARGE = $15 / TANK STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A COPA PROGRAM =$24.00/ FACILITY PERMANENT CLOSURE Removal or Permitted Closure in Place TANK ID # (s): CLOSURE FEE = $315 / TANK # TANKS X $315 = TEMPORARY CLOSURE Plan Review and Inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $315 / FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Inspections) TANK ID # (s) : I PLAN CHECK FEE = $840 / FACILITY REPAIR PLAN CHECK TANK ID # (s) : $ $ TANK RETROFIT REPAIR FEE = $345/ FACILITY (use for monitoring equipment, cold starts, EVR upgrades, spill buckets, sumps, misc. CONSULTATION FEE _ $ 105/ HOUR $ PIPING REPAIR FEE = $315 / FACILITY (use for piping, under -dispenser containment, ect.) UNAUTHORIZED RELEASE EVALUATION FEE = $ 105 / HOUR MISCELLANEOUS $ TRANSFER FEE _ $ 20 $ CONSULTATION FEE _ $ 105/ HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 105 / HOUR $ SAMPLING INSPECTION FEE _ $ 105/ HOUR ALL FEES ARE BASED ON THE $106 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. OFFICE USE ONLY SERVICE REQUEST #FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED SR EH 23 032 (REVISED 03/20/09)