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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave. , Stockton , CA 95205 -6232 ` <br /> Telephone: (209) 468-3420 For: (209) 468-3433 Weir. www. siechd.coni JAN 2 2 2019 <br /> FACILITY NAME FACILITY CONTACT NAME <br /> J&L Market Eugenie = , <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODE <br /> 8125 S EI Dorado St 209 982-0897 <br /> CITY STATE I ZIP CODE # OF TANKS ATSITE <br /> French Camp CA <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Elite IV Contractors <br /> Megan M <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> 2535 Wigwam Dr 209 461 -6337 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> Stockton Ca 95205 1 Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> $550 FEE INCLUDES FACILITY FEE + 1 TANK 2010 2011 2012 2013 2014 2015 <br /> $ 130 PER TANK AFTER FIRST TANK <br /> $ <br /> TANK PENALTY ASSESSED <br /> TANK SURCHARGE _ $ 15 / TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$35.00/ FACILITY <br /> PERMANENTCLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID # (s) : CLOSURE FEE = $390 / TANK # TANKS X $390 = $ <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections <br /> TANK ID # (s) : TEMPORARY CLOSURE FEE _ $390 / FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections <br /> TANK ID # (s) : PLAN CHECK FEE = $ 1040 / FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID # (s) : <br /> TANK RETROFIT REPAIR FEE _ $390 / FACILITY (use for monitoring equipment, cold starts , EVR upgrades, 456. 00 <br /> spill buckets, sum s, miser <br /> PIPING REPAIR FEE = $390 / FACILITY use for piping, under-dispenser containment, act. <br /> MISCELLANEOUS <br /> TRANSFER FEE = $ 25 $ <br /> CONSULTATION FEE _ $ 130/ HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $ 130 / HOUR $ <br /> SAMPLING INSPECTION FEE _ $ 130/ HOUR $ <br /> FEES ARE BASED ON THE $130 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT, <br /> TOTAL AMOUNT DUE $ <br /> OFFICE USE ONLY <br /> SERVICE REQUEST # I FACILITY ID AMOUNT RECEIVED I CHECK # I RECEIVED BY DATE RECEIVED <br /> EH 23 032 (REVISED 04.2245) <br />