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i <br /> OF JOAQ'UIN COUNTY <br /> ENVIAONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202x3029 <br /> Telepgojiev (209) +50420 Fax: (209) 468-3433 Web; wwwsiaov. orgle}id <br /> FACILITY NAME FACILITY.CONTACT NAME <br /> Chevron #208117 Debbie Rowe <br /> FACILITY ADDRESS SITE PHONE # WIT}t 'AREA CODE . <br /> 755 S Tracy Blvd , Tracy CA 95376 209-8 0-0370 <br /> i <br /> CITY STATE ZIP CODE #;OF TANKS :AT SITE <br /> Tracy CA 95376 3 <br /> APPLICANT BILLING NAME APPLiCANTCONTACT AME <br /> Service Station Systems . lnc Marty Weithman <br /> APPLICANT MAILING ADDRESS APP ICANTPHON #'WI.TH'AREA:C-ODE <br /> 680 Quinn Ave . 408- 213-6038 <br /> CITY .STATE ZIP CODE CIRCLE WORK TO BE!DONE CONTRACTOR IGC 41 <br /> San Jose CA 95112 u <br /> ACTIVE FACILITY <br /> 2004 2005 2006: 7007 2008 2009 <br /> $ 500 FEE INCLUDES FACILITY FEE + 1 TANK (2003=2008) <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:ALREAQY ON 1NVENTORY. IN A CUPA PROGRAM .=$24 ,601.FACILITY <br /> PERMANENT CLOSURE <br /> Remoyal .or Permitted Closure:in Place <br /> TANK.ID.# s : CLOSURE FEE_=. $3151 TANK . # TANKS X $315 = $ <br /> TEMPORARY CLOSUR_ E <br /> Plan Reylevw :and Ins ' ctions <br /> TANK ID # (s):_ TEMPORARY CLOSURE. FEE = $3.1.5 ! .FACILITY <br /> INSTALLATION PLAN CHECK OFF <br /> Plan Check and Cpnstruction Inspections) <br /> TANK ID # (s) : PLAN. CHECK FEE - $840. 1 FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID # `(s) : <br /> TANK RETROFIT REPAIR FEE _ $315 / FACILITY ( use for monitoring equipment, eold`starts; PVR upgrades , $ 684 <br /> s' ill .buckets, sum s, ,misc; <br /> PIPING .REPAIR FEE. = .$3151 FACILITY use for 1 in , under-dispenser bontainm. .erit, ect, <br /> MISCELLANEOUS <br /> TRANSFER FEE $ 20 $ <br /> .CONSULTATION FEE _ $ 1051HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATI.011 _ $ 1051 HOUR <br /> 177 <br /> SAMPLING INSPECTION FEE _ $ 1A51 HOUR t ` <br /> ALL FEES ARE BASED ON THE $105 HOURLY RATE, TIMETHAT EXCEEDS FEES PAD WILL BE BILLED TO APPLI ANT, t : 0 13 <br /> OFFICE USE ONLY <br /> SERVIC REQUEST # I FACILnY ID AMOUNT-RECEIVED CHECK # RECEIVED BY DATE RECEIVED , <br /> SR <br /> EH- 23 032 (REVISED 0212310 )) <br /> IF "a . I t <br />