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SAN J � � C � I � nvire� n �rrerrf l Health De gar . ria 6r : <br /> --- COUNTY-- a <br /> �s1, 1., t n c r) r' 0A -lcfri . <br /> FACILITY NAME FACILITY CONTACT NAME Jeet A P ' 4 LO ' U <br /> Manteca Liquor Food and Gas <br /> FACILITY ADDRESS SITE PHONE It WITH AREA CODE <br /> 890 N Main St ( 209 765 -2619 'HEALTHCITY STATE ZIP CODE F TANKS AT SITE �T <br /> Manteca CA 95336 <br /> APPLICANT BILLING NAME Elite IV Contractors APPLICANT CONTACT NAME Megan Mitchell <br /> APPLICANT MAILING ADDRESS 2535 Wigwam Dr APPLICANT PHONE It WITH AREA CODE <br /> 209 461 -6337 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> Stockton Ca 95205 Closure Installation Repair Retrofit <br /> I <br /> ACTIVE FACILITY <br /> i <br /> UST FEES = $ 550 2014 2015 UST FEES 2016 UST FEES 2017 VPH UST FEES = 2018 $ <br /> ( Facility+ 1st = $ 583 = $ 641 $961 Facility + <br /> Tank) + $ 130ITank Facility + Facility + $228fTank <br /> after list $ 139fTank $ 1521Tank <br /> Double Wall & 1702 $ <br /> Compliant UST <br /> FEES = $ 680 <br /> Facilit + $228/Tank <br /> Tank Penalty $ <br /> Assessed for <br /> Unreported Tanks <br /> (Based on Annual <br /> Permit Fees <br /> TANK SURCHARGE _ $20 / TANK <br /> $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM = $49.00/ FACILITY <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 Inspections <br /> $ <br /> TANK ID # (s) : TEMPORARY CLOSURE FEE = $ 456 / FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Ins ectlons <br /> $ <br /> TANK ID # (s) : PLAN CHECK FEE = $3 , 040 / FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID # (s) : <br /> $ <br /> TANK RETROFIT REPAIR FEE _ $ 4561 FACILITY ( use for monitoring equipment, cold starts , EVR upgrades , 456 .00 <br /> Spill buckets , sumps, misC. <br /> PIPING REPAIR FEE _ $456 / FACILITY use for piping, under-dispenser containment, etc. <br /> MISCELLANEOUS <br /> $ <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. <br /> TOTAL AMOUNT DUE $ <br /> OFFICE USE ONLY <br /> SERVICE REQUEST ii FACILITY 10 AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468-3420 1 F 209464-0138 1 www. sjcehd . coni <br />