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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTME`/ 600 East Main Street, Stockton, CA 95202-3029 i Telephone. (209) 468-3420 Far: (209) 468-3433 Web. www.ssmgov.org/ehd FACILITY NAME FACILITY CONTACT NAME Rancho San Miguel FACILITY ADDRESS Jesus Jurado SITE PHONE 0 WITH AREA CODE a 610 S Cherokee Lane, Lodi 209-3 9-8200 CITY STATE ZIP CODE. # OF TANKS AT SITE Lodi CA 95240 2 APPLICANT BILLING NAME APPLICANT CONTACT NAME Service Station Systems, Inc. MartWeithman APPLICANT MAILING ADDRESS APPLCA INT PHONE # WITH AREA CODE 680 Quinn Ave. 408 213-6038 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC It San Jose CA 95112 1-1 ED 1 8057571 ACTIVE FACILITY ff TANK ID # (a):CLOSURE FEE _ $315 /TANK # TANKS X $315 = $500 FEE INCLUDES FACILITY FEE + 1 TANK (2003-2008) $550 FEE INCLUDES FACILITY FEE + 1 TANK (2009) $125 PER TANK AFTER FIRST TANK 2004 2005 2006 2007 2008 2009 $ TANK PENALTY ASSESSED TANK SURCHARGE =$15ITANK TILITY$ STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$29.001 FAC PERMANENTCLOSURE Removal or Permitted Closure in Place ff TANK ID # (a):CLOSURE FEE _ $315 /TANK # TANKS X $315 = TEMPORARY CLOSURE Plan Review and inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $315 / FACILITY INSTALLATION PLAN TANK ID # REPAIR PLAN CHECK TANK ID # (s) $ TANK RETROFIT REPAIR FEE = $315 / FACILITY (use for monitoring equipment, cold starts. EVR upgrades, sill buckets, sum s misc. $ 390 PIPING REPAIR FEE = $315 / FACILITY use forpiping, under -dispenser containment, Oct. $ MISCELLANEOUS TRANSFER FEE = 20 $ CONSULTATION FEE = $ 105! HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 1051 HOUR $ SAMPLING INSPECTION FEE _ $ 105/ HOUR ALL FEES ARE BASED ON THE 5105 HOURLY RATE. TIME THAT Ere=Ena EM curt un, I _ $ TA!