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RECEIVED SAN JOAQUIN COUNTY V 0 9 2015 ENViRoNMENTAL HEALTH DEPARTMENT 1868 E. 5205-6232 Telephone.(209)46Hazelton 9 420 Fax.(209)46 34 3Web:www.sjceW.com wFaITww nl=oa ?T FAIT FACILITY NAME FACILITY CONTACT NAME Lathrop Shell Chris FACILITY ADDRESS SITE PHONE#WITH AREA CODE 16500 Harlan Rd 403-3859 CITY STATE ZIP CODE I #OF TANKS AT SITE Lathrop CA 95336 APPLICANT BILLING NAME APPLICANT CONTACT NAME Elite IV Contractors Kam White APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE 2535 Wigwam Dr. 20 461-6337 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# Closure Installation Repair Retrofit ACTIVE FACILITY $550 FEE INCLUDES FACILITY FEE t 1 TANK 2009 2010 2011 1 2012 2013 1 2014 $130 PER TANK AFTER FIRST TANK TANK PENALTY ASSESSED TANK SURCHARGE=$151 TANK STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$35.00!FACILITY $ PERMANENT CLOSURE Removal or Permitted Closure In Place TANK ID#(a): CLOSURE FEE_$3901 TANK #TANKS X$390= $ TEMPORARY CLOSURE Pian Review and Ins ons TANK ID#(s) TEMPORARY CLOSURE FEE=$3901 FACILITY INSTALLATION PLAN CHECK Plan Check and Construction i ns TANK ID#(s); PLAN CHECK FEE=$1040 f FACILITY REPAIR PLAN CHECK TANK ID#(s): TANK RETROFIT REPAIR FEE =$390 f FACILITY (use for monitoring equipment,cold stalls,EVR upgrades, 390.00 spill buckets,surnps,misc PIPING REPAIR FEE=$3901 FACILITY use for p1ping,under-dis nser owdainmerit.act. MISCELLANEOUS TRANSFER FEE = $25 $ CONSULTATION FEE = $1301 HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = 1301 HOUR $ SAMPLING INSPECTION FEE = $1301 HOUR $ FEES ARE BASED ON THE 130 HOURLY RATE.TIME THAT EXCEEDS FEES PAID YELL BE BILLED TO APPLICANT. TOTAL AMOUNT DUE $390.00 OFFICE USE ONLY SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED I CHECK 0 RECEIVED BY DATE RECEIVED EH 23 032 SED 14)