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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. Hazelton Ave., Stockton, CA 95205-6232 Telephone: (209) 468-3420 Far: (209) 468-3433 Web: www.§icchd.com FACILITY NAME FACILITY CONTACT NAME El Dorado Shell Bob Lutz FACILITY ADDRESS SITE PHONE # WITH AREA CODE 2320 El Dorado St A209) 943-1311 1 CITY STATE ZIP CODE # OF TANKS AT SITE I Stockton CA 95204 Li APPLICANT BILLING NAME APPLICANT CONTACT NAME Elite IV Contractors Megan Mitchell APPLICANT MAILING ADDRESS 2535 ft—wam Dr APPLICANT PHONE# WITH AREA CODE (209) 461-6337 1 CITY I STATE I ZIP CODE CIRCLE WORK TO BE DONE: CONTRACTOR ICC 7j Fn —n -1 rn 1 25 JRFL '� I Closure installation Repair Retrofit I ACTIVE FACILITY TANK ID # (s): --------- CLOSURE FEE = $390 / TANK 2010 2011 2012 2013 201 2015 $550 FEE INCLUDES FACILITY FEE + I TANK $ PIPING REPAIR FEE = $3901 FACILITY use for piping, under -dispenser containment, act.) 1 $ SAMPLING INSPECTION FEE $ 1301 HOUR $130 PER TANK AFTER FIRST TANK $ TANK PENALTY ASSESSED TANK SURCHARGE = $15 / 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 # (s): --------- CLOSURE FEE = $390 / TANK # TANKS X $390 TEMPORARY CLOSURE (Plan Review and Inspections) TANK ID # (s): TEMPORARY CLOSURE FEE = $3901 FACILITY TANK ID # (s): I PLAN CHECK FEE = $1040 / FACILITY REPAIR PLAN CHECK TANK ID # (s): $ TRANSFER FEE $25 TANK RETROFIT REPAIR FEE = $390 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, 456.00 spill buckets, sumps, misc.) $ PIPING REPAIR FEE = $3901 FACILITY use for piping, under -dispenser containment, act.) MISCELLANEOUS $ TRANSFER FEE $25 $ CONSULTATION FEE = $ 1301 HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 1301 HOUR $ SAMPLING INSPECTION FEE $ 1301 HOUR j't:raAKr0AaCWVr4 inr-*109f WM61 TOTAL AMOUNT DUE H