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SAN 0 A U I N <br /> EnvL U <br /> ironmental EGe Omw NAJ n� wmwm�Iq <br /> C O U N T Y <br /> IL OCT 12 ,2021 <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Short Stop Sam Hirsch <br /> ENVIRONMENIFACILITY ADDRESS SITE PHONE # WIT1361f, H REA CODE L HEALTH <br /> 20 W Turner Road t 209 ) 3 ;116 DEPARTMENT <br /> CITY STATE ZIP CODE # OF TANKS AT SITE <br /> Lodi CA 95240 <br /> 9PpLIC T ILLI G NAVEP (CANT CO TACT NAME <br /> hte � onracors ffe�orahones <br /> APPLICANT MAILING ADDRESS APLICANT PHO ITH AREA CODE <br /> 20 W Turner Road 209 461EES, <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> Stockton CA 95205 Closure Installation Repair Retrofit 1001331 <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) + $1301Tank Facility + Facility + $228rrank <br /> after 1st $139rrank $1521Tank <br /> Doubts 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 =$49.001 FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID # (s) : CLOSURE FEE = $4561 TANK # TANKS X $456 = $ 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 _ $3,0401 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, <br /> Spill buckets, sumps, misc. <br /> PIPING REPAIR FEE _ $456 / FACILITY use for piping, underAis enser 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 $ 456 <br /> OFFICE USE ONLY <br /> SERVICE REQUEST k FACILITY ID AMOUNT RECEIVED CHECK # I RECEIVED BY DATE RECEIVED <br /> 1868 E. Hazelton Avenue i Stockton , California 95205 ( T 209 468-3420 ( F 209 464-0138 i www.sjcehd .com <br /> i <br /> 1 <br /> C <br />