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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVISION <br />UNDF� '71INin CTCIRAC3F TANK DOnr-DAM Fr_ _"nDVCUCCT <br />FACILITY ......c <br />_.ITY CONTACT NAME <br />7 -Eleven #19976 <br />Manjit & Gurpal Grewal <br />FACILITY ADDRESS <br />SITE PHONE # WITH AREA CODE <br />1399 North Main Street <br />209-239-3252 <br />CITY <br />STATE <br />ZIP CODE <br /># OF TANKS @ SITE <br />Manteca <br />California <br />95336 <br />3 <br />APPLICANT BILLING NAME (Wo #124679) <br />APPLICANT CONTACT NAME <br />Sacramento Equipment Maintenance Company, Inc. <br />Linda Steiger <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />2533 Connie Drive <br />916-925-2716 <br />CITY <br />STATE <br />ZIP <br />CIRCLE WORK TO BE DONE: <br />Sacramento <br />CA <br />95815 <br />Closure Installation Repair Retrofit <br />ACTIVE FACILITY <br />FACILITY ID <br />TANK ID # (S): <br />$ 500 FEE INCLUDES FACILITY FEE + 1 TANK <br />$ 125 PER TANK AFTER FIRST TANK <br />1997-1999 <br />($170) x (# tanks) x (# of years applicable) <br />2000 <br />2001 <br />2002 <br />TANK ID # (S): <br />TEMPORARY CLOSURE FEE = $267 / FACILITY <br />f <br />El <br />TANK PENALTY ASSESSED <br />$ <br />TANK SURCHARGE = $ 10 / TANK <br />$ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM = $17.50 / FACILITY <br />$ <br />PERMANENT CLOSURE <br />(Removal of Permitted Closure in Place) <br />FACILITY ID <br />TANK ID # (S): <br />CLOSURE FEE = $ 267 / TANK <br /># TANKS x $ 267 = <br />$ <br />TEMPORARY CLOSURE <br />(Plan Review and Inspections) <br />$ <br />TANK ID # (S): <br />TEMPORARY CLOSURE FEE = $267 / FACILITY <br />f <br />INSTALLATION PLAN CHECK <br />(Plan Check and Construction Inspections) <br />TANK ID # (s): I PLAN CHECK FEE = $712 / FACILITY 1 $ <br />REPAIR PLAN CHECK <br />FACILITY ID <br />TANK ID # (s): <br />TANK LINING REPAIR FEE = $ 267 / TANK <br /># TANKS x $267 = <br />$ <br />TANK RETROFIT REPAIR FEE = $ 267 / FACILITY <br />$ <br />PIPING REPAIR FEE = $ 279 / FACILITY <br />$ 279.00 <br />MISCELLANEOUS <br />FACILITY ID <br />TRANSFER FEE = $ 20 <br />$ <br />CONSULTATION FEE = $ 89 / HOUR <br />$ <br />UNAUTHORIZED RELEASE EVALUATION FEE _ $ 89 / HOUR <br />$ <br />SAMPLING INSPECTION FEE = $ 89 / HOUR <br />$ <br />ALL FEES ARE BASED ON THE $ 89 HOURLY RATE TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br />nFFT[F IISF ONLY <br />SERVICE REQUEST # <br />FACILITY ID <br />AMOUNT RECEIVED <br />CHECK # <br />RECEIVED BY <br />DATE RECEIVED <br />SR <br />I <br />El <br />EH 23 032 (Revised 3/15/02 <br />V: \ county \ San Joaquin \ env \ forms \ permits \ repair54-fee worksheet <br />