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y � <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sieov.orP ehd <br /> FACILITY NAME I FACILITY CONTACT NAME <br /> MacArther Chevron <br /> FACILITY ADDRESS I SITE PHONE#WITH AREA CODE <br /> 3400 N MacArther 209 834-1220 <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> Tracy CA 95376 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Service Station Testing-SST INC Carl Wayne Henderson <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> PO Box 31465 209 1 465-5577 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> Stockton CA 95213 Closure Installation Repair Retrofit I 5252923-UT <br /> ACTIVE FACILITY <br /> 2004 2005 2006 2007 2008 2009 <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK(20032008) <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 COPA PROGRAM X24.001 FACILITY <br /> PERMANENTCLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID# s CLOSURE FEE=$315/TANK #TANKSX$315= <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <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_$840/FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(a): <br /> $366. $ <br /> TANK RETROFIT REPAIR FEE _$315/FACILITY (use for monitoring equipment,cold starts.EVR upgrades, 375.00 <br /> ill buckets,sumps,misc. <br /> PIPING REPAIR FEE $$315/FACILITY (use for piping.under-dis enser containment,ed $ <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $20 <br /> CONSULTATION FEE _ $105/HOUR <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $105/HOUR <br /> SAMPLING INSPECTION FEE _ $ RATE. <br /> ALL FEES ARE BASED ON THE$105 HOURLYLY RATE TME THAT EXCEEDS FEES PAID WILL BE BILLED i0 APPI3CANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILfrY ID I AMOUNTRECEIVED CHECK# I RECEIVED BY DATE RECEIVED <br /> SR <br /> EH 23 032(REVISED 02123/09) <br />