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MSAN JOAQUIN COUNTY ENVIRONMENTAL HEALTII DEPARTMENT 600 East Main Street,Stockton,CA 95202-3029 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www_.sigov.org/ehd FACILITY NAME FACILITY CONTACT NAME Alpha Fast Gas Jimmy FACILITY ADDRESS SITE PHONE#WITH AREA CODE 2358 E Waterloo Rd CITY STATE ZIP CODE #OF TANKS AT SITE Stockton CA 95205 APPLICANT BILLING NAME APPLICANT CONTACT NAME Service Station Testing-SST INC Carl Wayne Henderson APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE 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-UT ACTIVE FACILITY 2004 2005 2006 2007 2008 2009 $500 FEE INCLUDES FACILITY FEE+1 TANK(2003-2008) 5550 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 CLOSURE FEE_$3151 TANK #TANKS X$315 TANK ID#(s): = TEMPORARY CLOSURE Plan Review and Inspections) TANK ID#(s): TEMPORARY CLOSURE FEE=$315 1 FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Inspections) $ TANK ID#(s)- PLAN CHECK FEE=$840 1 FACILITY 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,misc. $366. $ PIPING REPAIR FEE _$315 1 FACILITY (use for piping,under-dispenser containment,ect.) MISCELLANEOUS $ TRANSFER FEE = S20 $ CONSULTATION FEE _ $1051 HOUR UNAUTHORIZED RELEASE EVALUATION FEE = $1051 HOUR $ SAMPLING INSPECTION FEE = $1051 HOUR ALL FEES ARE BASED ON THE$105 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. OFFICE USE ONLY SERVICE REQUEST# I FACILITY ID AMOUNT RECEIVED CHECK# I RECEIVED BY DATE RECEIVED SR I I —L EH 23 032(REVISED 02f23109)