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;19255517888 Main Fax GETTLER RYAN INC 2:47 p.m. 10-16-2007 4/10 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3d Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax(5"h floor):(209)468-3433 Web:www.siog v.or-/ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> ARCO 6080 <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 85 E LOUISE AVE 925 551-7555 <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> LATHROP CA 95330 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Gettler Ryan Inc. LIDDY MCKENZIE <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 6747 6747 Sierra Court,Suite J 925 551-7555 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> Dublin CA 94568 Closure Installation Repair Retrofit 5252315-UI <br /> ACTIVE FACILITY <br /> 2000 2001 2002 2003 20 2005 <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK <br /> $125 PER TANK AFTER FIRST TANK $ <br /> $ <br /> TANK PENALTY ASSESSED <br /> $ <br /> TANK SURCHARGE=$15/TANK <br /> $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$24.00/FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> $ <br /> TANK ID#(s): CLOSURE FEE=$279/TANK #TANKS X$279= <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TEMPORARY CLOSURE FEE_$279!FACILITY <br /> TANK ID#(s): <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> $ <br /> TANK ID#(s): PLAN CHECK FEE_$744/FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID# s <br /> TANK RETROFIT REPAIR FEE =$279/FACILITY (use for monitoringequipment,spill buckets,tank sumps,misc. $ 294 <br /> $ <br /> PIPING REPAIR FEE _$279/ FACILITY (use for piping,under-dispenser containment,ect. <br /> MISCELLANEOUS <br /> $ <br /> TRANSFER FEE _ $20 <br /> $ <br /> CONSULTATION FEE = $93/HOUR <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $93/HOUR <br /> SAMPLING INSPECTION FEE _ $93/HOUR <br /> ALL FEES ARE BASED ON THE$93 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BYDATE RECEIVED <br /> SR <br /> EH 23 032(REVISED 02122/05) <br />