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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 Webr www. sjgov. org/ehd FACILITY NAME FACILITY CONTACT NAME Rancho San Miguel Market Jesus Jurado FACILITY ADDRESS SITE PHONEE # WITH AREA CODE 1427 S Airport Way , 209-9 2-2840 CITY STATE ZIP CODE # OF TANKS AT SITE Stockton CA 95206 2 APPLICANT BILLING NAME APPLICANT CONTACT NAME Service Station Systems . lnc Marty Weithman APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE 680 Quinn Ave . 408- 213-6038 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR 1CC # San Jose CA 95112 ACTIVE FACILITY $ 500 FEE INCLUDES FACILITY FEE + 1 TANK (2003-2008) 2004 2005 2006 2007 2008 2009 $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 , 001 FACILITY $ PERMANENT CLOSURE Removal or Permitted Closure in Place TANK ID # (s) : CLOSURE FEE = $315 / TANK # TANKS X $315 = $ TEMPORARY CLOSURE Plan Review and Inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $315 / FACILITY $ INSTALLATION PLAN CHECK Plan Check and Construction Inspections ) TANK ID # (s) : PLAN CHECK FEE _ $8401 FACILITY $ REPAIR PLAN CHECK TANK ID # (s) : TANK RETROFIT REPAIR FEE _ $3151 FACILITY (use for monitoring equipment, cold starts, Enupgrades, $$ 456s ill buckePIPING REPAIR FEE _ $315 / FACILITY use for i in , under dis enser containment MISCELLANEOUS TRANSFER FEE _ $ 20 $ CONSULTATION FEE = $ 1051 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 I AMOUNT RECEIVED CHECK # I RECEIVED BY DATE RECEIVED SR EH 23 032 (REVISED 02/23/09)