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S Q N JOAQUIN Environmental Health Department <br /> ----C O U N T Y---- <br /> Greatness grows 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 TCA 95212 T2 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Chevron Greq 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 /> 92822 5252342 <br /> Brea CA Closure Installation Repair Retrofit <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 /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$49.00/FACILITY $ <br /> PERMANENTCLOSURE <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 /> 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 <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />