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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:n5D .s ov.or /ehd FACILItY CONTACT NAME FACILITY NAME Alpha Fast Gas Jimmy FACILITY ADDRESS SITE PHONE:9 NTH AREA CODE 2358 E Waterloo Rd ZIP CODE #OF TANKS AT SITE CITY STATE Stockton CA 95205 APPLICANT BILLING NAME APPLICANT CONTACT NAME Service Station Testing-SST INC Carl Wayne Henderson ADDRESS APPLICANT PHONE#WITH AREA CODE APPLICANT MAILING PO Box 31465 209 465-5577 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACtOR ICC# Stockton CA 95213 Closure Installation Repair Retrofit 5252923-1 IT ACTIVE FACILITY 2004 2005 2006 2007 2008 2009 $500 FEE INCLUDES FACILITY FEE+1 TANK(2003-2008) $550 FEE INCLUDES FACILITY FEE+1 TANK(2009) $125 PER TANK AFTER FIRST TANK $ TANK PENALTY ASSESSED $ TANK SURCHARGE=$151 TANK $ STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$24.00!FACILITY PERMANENT CLOSURE Removal or Permitted Closure in Place $ TANK ID# s : CLOSURE FEE=$3151 TANK #TANKS X$315= TEMPORARY CLOSURE Plan Review and Inspections) $ TANK ID#(5): TEMPORARY CLOSURE FEE=$315!FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Inspections) PLAN CHECK FEE_$840 1 FACILITY TANK ID#(s) REPAIR PLAN CHECK TANK ID#(s): $ $366. TANK RETROFIT REPAIR FEE =$315 1 FACILITY (use for monitoring equipment,cold starts,EVR upgrades, 375.00 spill buckets,sumps,mist.) $ $366' use forpiping,under dis eraser containment,ect. PIPING REPAIR FEE =$315/FACILITY MISCELLANEOUS $ TRANSFER FEE _ $20 $ CONSULTATION FEE = $1051 HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE _ $1051 HOUR $ SAMPLING INSPECTION FEE = $1051 HOUR ALL FEES ARE BASED ON THE S1D5 HOURLY RTI ATE. ME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. OFFICE USE ONLY FACILITY ID NTRECEIVED CHECK# RECEIVED BY DATE RE SERVICE REQUEST# CEIVED SR EH 23 032(REVISED 07J23109)