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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202 .3029 <br /> Telephone: (209) 468-3420 Far: (209 ) 468-3433 Web: www,sigov. ora/ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Safeway #2600 Will Kaufman <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODE <br /> 1987 W 11th St, Tracy CA 95376 209-8 0-2950 <br /> CITY STATE ZIP CODE # OF TANKS AT SITE <br /> Tracy CA 95376 3 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Service Station Systems . lnc <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 TODONE CONTRACTOR ICC # <br /> San Jose CA 95112 It; <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 =$24 . 00/ FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID # (s ) : CLOSURE FEE = $3151 TANK # TANKS X $315 = $ <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK 1D # (s) : TEMPORARY CLOSURE FEE _ $3151 FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan 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 _ $3151 FACILITY (use for monitoring equipment, cold starts, EVR upgrades, $ 456 <br /> spill buckets, sumps, misc. <br /> PIPING REPAIR FEE _ $3151 FACILITY use for piping, under-dispenser containment, act. $ <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $ 20 $ <br /> CONSULTATION FEE _ $ 105/ HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $ 105 / HOUR $ <br /> SAMPLING INSPECTION FEE _ $ 105/ HOUR $ <br /> ALL FEES ARE BASED ON THE $ 105 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT, <br /> OFFICE USE ONLY <br /> SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br /> SR <br /> EH 23 032 (REVISED 02/23109) <br />