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SAN ,J O Q U N Environmental Health Department <br /> I COUNTY __ -- <br /> ( reatncs , gra4vs here, <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Chevron Stations Inc . #208118 Station Manager <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODE <br /> 3355 E . Hammer Lane ( 209 )477-3699 <br /> CITY STATE ZIP CODE # OF TANKS AT SITE <br /> Stockton CA 95212 2 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Chevron Greg Hohn <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> PO Box 2292 ( 714 ) 671 -3265 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> Brea CA 92 $22 Closure Installation Repair Retrofit 5252342 <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 + $228/Tank <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 /> 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 /> TANK ID # (s) : CLOSURE FEE = $456 / TANK # TANKS X $456 = $ <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID # (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 REPAIR FEE _ $456 / FACILITY (use for monitoring equipment, cold starts , EVR upgrades , $ 456 . 00 <br /> S ill buckets , sum s , mise. <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 <br /> OFFICE USE ONLY <br /> SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED 7 CHECK # RECEIVED BY DATE RECEIVED <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468-3420 F 209 464 -0138 1 www. sjcehd . com <br />