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SAN JOAQUIN COt1NTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone:(209)468-3420 Far: (209)468-3433 Web:www.sigov.org/ehd ehd FACILITY NAME FACILITY CONTACT NAME Arco 2186 Scott Listar FACILITY ADDRESS SITE PHONE#WITH AREA CODE 3212 N. California Street 209-941-2694 CITY STATE ZIP CODE #OF TANKS AT SITE Stcokton I CA 95204 13 APPLICANT BILLING NAME APPLICANT CONTACT NAME Gettler-Ryan Inc. Randy Brown APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE 6747 Sierra Court Suite J 25-551-7555 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# Dublin Ica 194568 1 Closure Installation Repair Retrofit ACTIVE FACILITY 2006 2007 2008 2009 2010 2011 $500❑❑❑INCL❑D❑S❑ACILIT❑❑❑D❑1 TAN❑[2006-2007 $550❑O❑INCL❑D❑S❑ACILIT❑❑D❑❑1 TAN❑2008-2011 $ $125 PF--]R TAN❑ADT❑R❑IRST TAN❑ TANG PONALTCI ASS❑SS❑D TAN❑S❑RC❑ARG❑El$15 STAND STAT" S RCI ARG- -iOR ]ACILITI❑S NOT ALR[IAD❑ N IN❑-NT R IN A C PA PR GRAM $49.00 ACILIT PERMANENT CLOSURE Removal or Permitted Closure in Place TAN-]ID# s CL❑S❑RD EIDE]L$375 TAN_ #TAN❑S❑$375 TEMPORARY CLOSURE Plan Review and Inspections TAN ID# s T,,MPuRAR❑CL❑S❑R❑❑❑❑Li$375 ❑❑ACILIT❑ INSTALLATION PLAN CHECK Plan C eck and Construction Inspections TAN ID# s PLAN C $1,000 ACILIT REPAIR PLAN CHECK Red Jacket Transducer replacement on 91 turbine. # A45662 TANDID# s Premium Tank TAN R-TR❑DIT REPAIR 117 - $375 --ACILIT- use for monitoring a uipment,cold starts, R upgrades, spill buckets,sumps,misc. PIPING R PAIR"'Ti❑$375' 9-JACILIT❑ use for piping,under-dispenser containment,ect. $375 MISCELLANEOUS TRANS'.IER $25 $ C❑NS❑LTATI❑N D❑❑ 11 $125 R $ ❑NA❑T❑❑RI❑r!D R�IL❑AS❑DDALEIATIDN OF $ 125 R $ SAMPLING INSP CTI❑N ❑ $125 R $ ALL FEES ARE BASED ON THE$125 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. TOTAL AMOUNT DUE Is OFFICE USE ONLY SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED EH 23 032(REVISED 08/1/11 by KF)