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SAN JOAOUIN COUNTY ENVIRONMENTAL HEAL -1-1 l DEPARI MEN'I' 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: wwWA.gov.org/eh RECEIVED FEB 2 5 201.4 ENVIRONMENTAL ENT FACILITY NAME FACILITY CONTACT NAME Valley Pacific Fresno Ave Cardlock Mike Eliason FACILITY ADDRESS SITE PHONE # WITH AREA CODE 1524 Fresno Ave 209 993-8793 CITY STATE ZIP CODE # OF TANKS AT SITE Stockton CA 95206 1 APPLICANT BILLING NAME APPLICANT CONTACT NAME Valley Pacific Petroleum Services, Inc Mike Eliason APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE 166 Frank West Circle 209 993-8793 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # PIPING REPAIR FEE = $375 / FACILITY use for piping, under -dispenser containment, ect.) Closure Installation <5-epair Retrofit $ ACTIVE FACILITY TANK ID # (s): CLOSURE FEE = $375 / TANK 2007 2008 2009 2010 2011 2012 $500 FEE INCLUDES FACILITY FEE + 1 TANK (2007-2008) $ PIPING REPAIR FEE = $375 / FACILITY use for piping, under -dispenser containment, ect.) $ 1 $550 FEE INCLUDES FACILITY FEE + 1 TANK (2009-2012) $ $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 =$49.00/ FACILITY PERMANENT CLOSURE Removal or Permitted Closure in Place TANK ID # (s): CLOSURE FEE = $375 / TANK # TANKS X $375 = TEMPORARY CLOSURE Plan Review and Inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $375 / FACILITY INSTALLATION PLAN CHECK (Plan Check and Construction Ir TANK ID # PLAN CHECK FEE = $1000 / FACILITY REPAIR PLAN CHECK TANK ID # (s) : $ TRANSFER FEE _ $ 25 $ TANK RETROFIT REPAIR FEE = $375 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, $ spill buckets, sumps, mist. $ PIPING REPAIR FEE = $375 / FACILITY use for piping, under -dispenser containment, ect.) MISCELLANEOUS $ TRANSFER FEE _ $ 25 $ CONSULTATION FEE = $ 125/ HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 125 / HOUR $ SAMPLING INSPECTION FEE = $ 125/ HOUR ALL FEES ARE BASED ON THE $125 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. TOTAL AMOUNT DUE $ OFFICE USE ONLY EH 23 032 (REVISED 04/13/12 by KF)