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:?P,0!514 34.4 - PC 3 Sl <br /> SAN 10AQUIN EnvironmAa�"hH'- <br /> alth n <br /> COUNTY <br /> grows <br /> FACILITY NAME FACILITY CONTACT NAME 18 <br /> 7-Fleven#38153 Aparna Ion . <br /> FACILITY ADDRESS SITE HONE#WI H AREA CODE 1 11::1 L"CFI <br /> W. Market St. # S. Center Street 129 53 -7L-fq6 1 3,11 N-I- <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> Stockton CA 95202 3 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Walton Engineering, Inc. Angel Rodriguez <br /> APPLICANT MAILING ADDR SS APPLICANT PHON #WITH AREA CODE <br /> P.O. Box 1025 ( 916-373-1165 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> West Sacramento CA 95616 1 Closure nstallation Repair Retrofit 1 8185848 <br /> ACTIVE FACILITY <br /> UST FEES= $550 2013 2014 2015 UST FEES= 2016 UST FEES= 2017 2018 <br /> (Facility+1st Tank)+ $583 Facility+ $641 Facility <br /> $130/Tank after 1st $139/Tank +$152/Tank <br /> $641 <br /> Tank Penalty Assessed for <br /> Unreported Tanks(Based on $456 <br /> Annual Permit Fees <br /> TANK SURCHARGE_$20/TANK <br /> J 20 $ 60 <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$49.00/FACILITY $ 49 <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> $ <br /> TANK ID#(s) : CLOSURE FEE=$456/TANK #TANKS X$456= <br /> TEMPORARY CLOSURE <br /> Plan Review and Ins ections <br /> $ <br /> TANK ID#(s): TEMPORARY CLOSURE FEE=$456/FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> TANK ID#(s): PLAN CHECK FEE=$1,216/FACILITY $1216 <br /> REPAIR PLAN CHECK <br /> t�( <br /> TANK ID#(s) <br /> $ <br /> TANK RETROFIT REPAIR FEE =$456/FACILITY (use for monitoring equipment,cold starts, EVR upgrades, <br /> spill buckets,sumps.misc. <br /> $ <br /> PIPING REPAIR FEE=$456/FACILITY use for piping,under-dispenser containment.ect. <br /> MISCELLANEOUS <br /> TRANSFER FEE = $25 $ <br /> CONSULTATION FEE _ $152/HOUR $ £►�� <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $ 152/HOUR <br /> SAMPLING INSPECTION FEE = $ 152/HOUR $ <br /> FEES ARE BASED ON THE$152 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. N JO J ZOIB <br /> TOTAL AMOUNT DUE $lam UNC04)Nj). <br /> OFFICE USE ONLY M ,yr <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED <br /> e,4co I91-7 1 pftD.!�4495, 1.2-0 - -ff 5 35 q- L,6,, <br /> 0 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sjcehd.com <br />