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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.or /g ehd <br />FACILITY NAME <br />FACILITY CONTACT NAME <br />Ol ian #427 <br />ca Freitas <br />FACILITY ADDRESS <br />SITE PHONE # WITH AREA CODE <br />3300 Waterloo Road <br />73-1167 <br />CITY <br />STATE ZIP CODE <br /># OF TANKS AT SITE <br />Stockton, CA 95205 <br />1 CA 95205 <br />3 <br />APPLICANT BILLING NAME <br />T CONTACT NAME <br />Walton En inerin , Inc. <br />ca Freitas <br />APPLICANT MAILING ADDRESS <br />EAPPLICANTPHONE # WITH AREA CODE <br />P.O. Box 1025 <br />73-1167 <br />CITY <br />STATE <br />I ZIP CODE CIRCLE WORK TO DONE CONTRACTOR ICC # <br />West Sacramento <br />I CA <br />1 95691 Closure Installation fiepair) Retrofit <br />EM A <br />ACTIVE FACILITY <br />TANK ID # (s): <br />CLOSURE FEE = $375 / TANK <br />2008 <br />2009 <br />2010 <br />2011 <br />2012 <br />2013 <br />$ <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK (2007-2008) <br />PIPING REPAIR FEE = $375 / FACILITY use for piping, under -dispenser containment, ect. <br />375 <br />$550 FEE INCLUDES FACILITY FEE + 1 TANK (2009-2012) <br />$ <br />$125 PER TANK AFTER FIRST TANK <br />$ <br />TANK PENALTY ASSESSED <br />$ <br />TANK SURCHARGE = $15 / TANK <br />$ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$35.00/ FACILITY <br />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # (s): <br />CLOSURE FEE = $375 / TANK <br /># TANKS X $375 = <br />TEMPORARY CLOSURE <br />Plan Review and Inspections) <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = $375 / FACILITY <br />INST <br />Check and Construction <br />TANK ID # <br />PLAN CHECK FEE = $1000 / FACILITY <br />REPAIR PLAN CHECK <br />TANK ID#(s): <br />$ <br />$ <br />TANK RETROFIT REPAIR FEE = $375 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 125 /HOUR <br />spill buckets, sumps, misc. <br />SAMPLING INSPECTION FEE = $ 125/ HOUR <br />$ <br />$ <br />PIPING REPAIR FEE = $375 / FACILITY use for piping, under -dispenser containment, ect. <br />375 <br />MISCELLANEOUS <br />TRANSFER FEE _ $ 25 <br />$ <br />CONSULTATION FEE = $ 125/ HOUR <br />$ <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 125 /HOUR <br />$ <br />SAMPLING INSPECTION FEE = $ 125/ HOUR <br />$ <br />ALL FEES ARE t3ASLU UN T RE $125 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br />TOTAL AMOUNT DUE $ <br />OFFICE USE ONLY <br />EH 23 032 (REVISED 1/16%1013 by KF) <br />