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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.sl'RovL--Qrg/ehd FACILITY NAME FACILITY CONTACT NAME Chevron USA manager FACILITY ADDRESS SITE PHONE N WITH AREA 10858 Trinity Parkway Stockton CA 95219 209-9 12-2213 CITY STATE ZIP CODE Stockton CA 95213 ArrucAN I BILLING NAME APPLICANT CONTACT NAME Service Station Systems, Inc. Marty Weithman APPLICANT MAILING ADDRESS APPLICANT PHONE X WITH AREA CODE 680 Quinn Ave. 408 213-6038 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC San Jose CA 95112 0 5261142 -UT ACTIVE FACILITY $500 FEE INCLUDES FACILITY FEE + 1 TANK (2003-2008) 2004 2005 2006 2007 2008 2009 $550 FEE INCLUDES FACILITY FEE + 1 TANK (2009) $125 PER TANK AFTER FIRST TANK $ TANK PENALTY ASSESSED $ TANK SURCHARGE = $15 I TANK $ STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY INA CUPA PROGRAM =$24.00/ FACILITY $ PERMANENT CLOSURE Removal or Permitted Closure in Piace 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 Ins TANK ID # (s) I PLAN CHECK FEE =$840 /FACILITY - 7$ - REPAIR PLAN CHECK TANK ID # (s) : TANK RETROFIT REPAIR FEE = $315 / FACILITY (use for monitoring equipment, cold starts. EVR upgrades, s ill buckets, sum s, misc. PIPING REPAIR FEE = $315 / FACILITY use for piping, under -dispenser containment, ect. 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 $105 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. 345 $ $ $ $ FFICE USE ONLY ERYICE REQUEST* FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED R 123 032 (REVISED 02!23/09)