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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:www.sipov.or>?/ehd FACILITY NAME FACILITY CONTACT NAME ARCO- Manteca Jessie FACILITY ADDRESS SITE PHONE#WITH AREA CODE 1100 S Main St 209 825-6784 CIN STATE ZIP CODE #OF TANKS AT SITE Manteca CA 95337 APPLICANT BILLING NAME APPLICANT CONTACT NAME HMC - Henderson Maintenance Company Carl Wayne Henderson APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE PO Box 31325 209 467-7573 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# Stockton CA 95213 Closure Installation Repair Retrofit T 5252923-UT 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=$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 $345. TANK ID# s CLOSURE $345. 3$315 �TANKSX$315= $ TEMPORARY CLOSURE Plan Review and Inspections) $345. $ TANK ID#(s): TEMPORARY CLOSURE FEE=$315/FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Inspections) $ TANK ID#(s): PLAN CHECK FEE=$840/FACILITY REPAIR PLAN CHECK TANK ID#(s) $345. $345.00 TANK RETROFIT REPAIR FEE =$315/FACILITY (use for monitoring equipment,cold starts,EVR upgrades, spill buckets,sumps,misc. $345. $ PIPING REPAIR FEE _$315/FACILITY (use forpiping,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(REVISED 02123/09)