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A N . 10 A Q U I EnAronme tal Health Department <br /> -- - COUNTY <br /> FACILITY NAME FACILITY CONTACT NAME Vikash <br /> Save On Fuel <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODE <br /> 420 W Yosemite Ave ( 209 ) 239-4700 <br /> STATE ZIP CODE # OF TANKS AT SITE <br /> CITY 95337 <br /> Manteca CA <br /> APPLICANT BILLING NAMEElite IV Contractors APPLICANT CONTACT NAME Megan M <br /> APPLICANT MAILING ADDRESS 2535 Wigwam Dr APPLICANT PHONE # WITH AREA CODE <br /> 2p9 461 -6337 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> Stockton Ca 95205 Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> UST FEES 2016 UST FEES 2017 VPH UST FEES = 2018 $ <br /> USTFEES = $ 550 2014 2015 _ $ 583 = $641 $961 Facility + <br /> (Facility+1st Facility + Facility + $2281Tank <br /> Tank) + $1301Tank $139rrank $ 152(rank $ <br /> after 1st Double Wall & 1702 <br /> Compliant UST <br /> FEES = $680 <br /> Facility + $228rrank <br /> Tank Penalty <br /> Assessed for <br /> Unreported Tanks <br /> (Based on Annual <br /> Permit Fees) $ <br /> TANK SURCHARGE = $20 / TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$49.007FAC71LITY <br /> Po <br /> ENT CLOSURE <br /> l r Permitted Closure in Place $ <br /> # (s) : CLOSURE FEE _ $4561 TANK # TANKS X $456 = <br /> RARY CLOSUREview and Ins ections# (s) : TEMPORARY CLOSURE FEE _ $456 ! FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) $ <br /> TANK ID # (s) : PLAN CHECK FEE _ $3 ,040 / FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID # (s) : $ <br /> TANK RETROFIT REPA7FEE $456 r FACILITY (use form II buying equipmsums miscd starts , EVR upgrades, 456 .00 <br /> PIPING REPAIR FEE = ACILITY use for 2iping, under4s enser containment, eta <br /> MISCELLANEOUS $ <br /> TRANSFER FEE = $ 25 $ <br /> CONSULTATION FEE _ $ 152/ HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $ 1521 HOUR $ <br /> SAMPLING INSPECTION FEE _ $ 1521 HOUR <br /> FEES ARE BASED ON THE 5152 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> Fs <br /> =TOTAL DUE <br /> OFFICE USE ONLYMINERECEIVED BY DATE RECEIVED <br /> SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468-3420 F 209 464-0138 www.sjcehd .com <br />