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SAN JOAQUIN COUNTY 0 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sip-ov.org/ehd <br />FACILITY NAME <br />FACILITY CONTACT NAME <br />EI Dorado Food Mart ( SHELL) <br />Bob Lutz <br />FACILITY ADDRESS <br />SITE PHONE # WITH AREA CODE <br />2320 N EI Dorado St <br />209 467-7573 <br />CITY STATE <br />ZIP CODE # OF TANKS AT SITE <br />Stockton CA <br />95209 <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />HMC - Henderson Maintenance Company <br />Carl Wayne Henderson <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />PO Box 31325 <br />209 467-7573 <br />CITY <br />I STATE <br />ZIP CODE <br />CIRCLE WORK TO BE DONE <br />CONTRACTOR ICC # <br />Stockton <br />I CA <br />1 95213 <br />Closure Installation Repair Retrofit <br />5252923 -UT <br />ACTIVE FACILITY <br />TANK ID # (s): <br />CLOSURE FEE = $315 / TANK <br />2004 <br />2005 <br />2006 <br />2007 <br />2008 <br />2009 <br />$345. <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK (2003-2008) <br />PIPING REPAIR FEE = $315 / FACILITY (use for piping, under -dispenser containment, ect.) <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 105 / HOUR <br />$ <br />SAMPLING INSPECTION FEE _ $ 105/ HOUR <br />$550 FEE INCLUDES FACILITY FEE + 1 TANK (2009) <br />$125 PER TANK AFTER FIRST TANK <br />$ <br />$ <br />TANK PENALTY ASSESSED <br />$ <br />TANK SURCHARGE = $15 /TANK <br />Is <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$24.00/ FACILITY <br />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # (s): <br />CLOSURE FEE = $315 / TANK <br /># TANKS X $315 = <br />TEMPORARY CLOSURE <br />Plan Review and Inspections) <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = $315 / FACILITY <br />PLAN CHECK <br />Construction Ir <br />TANK ID # (s) : I PLAN CHECK FEE = $840 / FACILITY <br />$ <br />REPAIR PLAN CHECK <br />TANK ID # (s) : <br />$345. <br />$ <br />TANK RETROFIT REPAIR FEE = $315 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, <br />345.00 <br />spill buckets, sumps, misc.) <br />CONSULTATION FEE _ $ 105/ HOUR <br />$345. <br />$ <br />PIPING REPAIR FEE = $315 / FACILITY (use for piping, under -dispenser containment, ect.) <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 105 / HOUR <br />MISCELLANEOUS <br />$ <br />TRANSFER FEE _ $ 20 <br />$ <br />CONSULTATION FEE _ $ 105/ HOUR <br />$ <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 105 / HOUR <br />$ <br />SAMPLING INSPECTION FEE _ $ 105/ HOUR <br />ALL FEES ARE BASED ON THE $105 HOURLY RATE. TIME THA I txuttus rtES vAiu Wi L BE BiLLtu O ArruCAry T. <br />OFFICE USE ONLY <br />