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t � t <br /> Q I 0 Q Environmental Health Department <br /> -- COUNTY <br /> , : G' 100n6' gro'S fIr- rc <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Shell Joe Dangiran <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODE <br /> 717 W 8TH Street ( 408 ) 666-0009 <br /> CITY STATE ZIP CODE # OF TANKS AT SITE <br /> Stockton CA 95206 <br /> APPLICANT BILLING NAME Elite IV Contractors APPLICANT CONTACT NAME Megan Mitchell <br /> APPLICANT MAILING ADDRESS 2535 Wigwam Dr APPLICANT CANT H3 <br /> ONE7WITH AREA CODE <br /> CITY Stockton STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> Ca 95205 Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> UST FEES = $550 2014 2015 UST FEES 2016 UST FEES 2017 VPN UST FEES = 2018 $ <br /> (Facility+1st = $583 = $641 $961 Facility + <br /> Tank) + $130/Tank Facility + Facility + $228/Tank <br /> after 1st $1391Tank $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 _ $201 TANK <br /> $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A COPA PROGRAM =$49 .00/ FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> $ <br /> TANK ID # (s) : CLOSURE FEE = $4561 TANK # TANKS X $456 = <br /> TEMPORARY CLOSURE <br /> Pian 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 I 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 .00 <br /> Spill buckets, sumps, Misc. <br /> $ <br /> PIPING REPAIR FEE _ $456 / FACILITY (use for piping, under-dispenser containment, eta <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $ 25 $ <br /> CONSULTATION FEE _ $ 1521 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 $ <br /> OFFICE USE ONLY <br /> SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br /> NP <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468-3420 F 209 464 -0138 ( www.sjcehd .com <br /> j <br /> f <br />