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SAN JOAQU",,COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.siAov.orelehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Shell(Tesoro) Mary Morgan <br /> FACILITY ADDRESS SITE PHONE*WITH AREA CODE <br /> 2448 Kettleman Lane, Lodi -09-31-9-3124 <br /> CITY STATE ZIP CODE <br /> #OF TANKS AT SITE <br /> Lodi <br /> CA 3 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Able Maintenance, Inc Mart Weithman <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 680 Quinn Ave. <br /> 408 213-6038 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BEfLj[!Z�0:;] 5 <br /> NTRACTOR ICC# <br /> San Jose CA 95112 <br /> 52032-UI <br /> ACTIVE FACILITY <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK(2003-2008) 2004 2005 2006 2007 2008 2009 <br /> $550 FEE INCLUDES FACILITY FEE+ 1 TANK(2009) <br /> $125 PER TANK AFTER FIRST TANK $ <br /> TANK PENA-TYASSESSED $ <br /> TANK SURCHARGE=$15/TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$2q.p0/FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID# s CLOSURE FEE=5315/TANK #TANKS X$315= $ <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID#(s): TEMPORARY CLOSURE FEE_$315/FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> TANK ID#(s): PLAN CHECK FEE_$840/FACILITY $ <br /> rREPR <br /> HECK <br /> T REPAIR FEE _$315/FACILITY (use for monitoring equipment,cold starts,EVR upgrades, $ <br /> s ill buckets,sum s mist. <br /> FEE =$315/FACILITY use for piping,under-dispenser containment,ect, $ 366 <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $20 APLICANT CONSULTATION FEE = $ 105/HOUR <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $ 105/HOUR <br /> SAMPLING INSPECTION FEE = $105/HOUR <br /> ALL FEES ARE BASED ON THE 5105 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE EBILLED . <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK K RECEIVED BY DATE RECEIVED <br /> SR <br /> EH 23 032(REVISED 02123109) <br />