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Environment �� V ® <br /> Q , SAN JOAQUIN , <br /> U-PP' iCOUNTY <br /> r r „ I , , r ho [ (3 . <br /> JUN 1 9 20 � U <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Lodi Muni Service Center , City of Lodi Randy Laney `I p HEALTH <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODE DEEPART pE IT <br /> 1331 S Ham Ln ( 209 ) 333 - 6800 re IVt V <br /> CITY STATE ZIP CODE # OF TANKS AT SITE <br /> Lodi CA 95242 3 <br /> APPLICANT BILLING NAME Bagley Enterprises , Inc . APPLJoe TBagley <br /> TACT NAME <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> 2370 Maggio Cir F#4 �( 2.09) 3674800 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> Lodi CA 95240 Closure Installation Repair Retrofit 8881020 <br /> ACTIVE FACILITY <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 ) + $ 130/Tank Facility + Facility + $ 2281Tank <br /> after 1st $ 139/Tank $ 152/Tank <br /> Double Wall & 1702 $ <br /> Compliant UST <br /> FEES = $680 <br /> Facility + $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 Inspections) <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 _ $456 / FACILITY ( use for monitoring equipment , cold starts , EVR upgrades , 456 . <br /> Spill buckets , sumps , misc. <br /> PIPING REPAIR FEE _ $456 / FACILITY use for piping , under-dispenser containment, etc. <br /> MISCELLANEOUS <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 $ 456 . <br /> OFFICE USE ONLY <br /> SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br /> 3420 F 209 464 - 0138 www . sjcehd . com <br /> 1868 E . Hazelton Avenue Stockton , California 95205 I T 209 468 I I 1 <br /> I <br />