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925551789§ Line 1 11•^1•40 a.m. 06-15-2010 6/6 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH 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 ARCO-2186 FACILITY ADDRESS SITE PHONE#WITH AREA CODE 3212 N CALIFORNIA 925 551-7555 CITY STATE ZIP CODE #OF TANKS AT SITE STOCKTON CA 95204 APPLICANT BILLING NAME APPLICANT CONTACT NAME Gettler Ryan Inc. LIDDY MCKENZIE APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE 6747 6747 Sierra Court,Suite J 925 551-7555 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# Dublin CA 94568 Closure Installation Repair Retrofit 8018952-UI ACTIVE FACILITY 2004 2005 2006 2007 2008 2009 $500 FEE INCLUDES FACILITY FEE+1 TANK(2004-2007) $550 FEE INCLUDES FACILITY FEE+1 TANK(2008-2009) $125 PER TANK AFTER FIRST TANK $ $ TANK PENALTY ASSESSED $ TANK SURCHARGE=$15!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=$315/TANK #TANKS X$315= TEMPORARY CLOSURE Pian Review and Inspections) $ TANK ID#(s): TEMPORARY CLOSURE FEE_$315!FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Inspections) $ TANK ID#(s): I PLAN CHECK FEE_$840!FACILITY REPAIR PLAN CHECK TANK ID#(s): $ TANK RETROFIT REPAIR FEE =$315/FACILITY (use for monitoring equipment,cold starts,EVR upgrades, 345 spill buckets,sumps,misc. $ PIPING REPAIR FEE _$315/FACILITY (use for piping,under-dispenser containment,ect.) MISCELLANEOUS $ TRANSFER FEE _ $20 $ CONSULTATION FEE _ $105/HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE _ $105/HOUR $ SAMPLING INSPECTION FEE _ $105/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# FACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED SR EH 23 032 tREVISED 03120109)