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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:AM .sj ov. r ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Shell Javier <br /> FACILITY ADDRESS SITE PHONEPHONE#WITH AREA CODE <br /> 2375 W Grant Line 209-8 6-8908 <br /> CITY STATE TIP CODE 4-0— TANKS AT SITE <br /> Tracy CA 95376 <br /> 4 <br /> APPLICANT BILLING"NAME APPLICANT CONTACT NAME <br /> Service Station Systems, Inc. <br /> Marty Weithman <br /> APPLICANT MAILING ADDRESS APPLICANT P---NE#WITH`AR-A CODE <br /> 680 Quinn Ave. <br /> 408 213-6038 <br /> CITY STATE ZlP CODE CIRCLE WORK TO BE NE CONTRACTOR ICC# <br /> San Jose El CA 95112 ® ® 8001468-UT <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 PENALTY ASSESSED $ <br /> TANK SURCHARGE_$15/TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$24-0D/FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID# s : CLOSURE FEE=,,13151 TANK #TANKS X$315= $ <br /> TEMPORARY CLOSURE <br /> Plan RevIOW en In dons <br /> TANK ID#(s): TEMPORARY CLOSURE FEE= FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Ins 2ggM <br /> TANK ID#(s): PLAN CHECK FEE=$840/FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID#(s) <br /> TANK RETROFIT REPAIR FEE =$3151 FACILITY (use for monftodns equipment,cold starts;EVR upgrades, $ 345 <br /> s Irl bucket$ sumps,misc. <br /> PIPING REPAIR FEE _$315/FACILITY use for ,under-dispenser containment,w. $ <br /> MISCELLANEOUS <br /> TRANSFER FEE = 20 $ <br /> CONSULTATION FEE _ $105/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $105/HOUR <br /> $ <br /> SAMPLING INSPECTION FEE = $105/HOUR $ <br /> ALL FEES ARE BASED ON THE$105 HOURLY RATE.TIME THAT EXCEEDS FEES PAID WILL BE BILLED T®APPLICANT. <br /> OFFICE USE ONLY <br /> [SR <br /> VICE REQUEST#t FACILITY ID AMOUNT REGENED HE-C--K-# REGENEp BY DATE RECEIVED <br /> EH sa O32(REVISED O ) <br />