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RECEIVED <br /> SAN 11 A � U I N Environmental Healf I� j llertf <br /> — C CSU NTY _ _._. r <br /> Lu <br /> ENVIRONMENTAL HEALTH <br /> UNDERGROUND STORAGE TANK FEE WORKSHEET T <br /> FACILITY NAME DATE <br /> Orlando ' s Market 9/28/2021 <br /> FACILITY ADDRESS CITY STATE ZIP CODE <br /> 18754 State Route 26 Linden CA 95236 <br /> SERVICE REQUEST (CHOOSE ONE ) FEE SUBTOTAL <br /> Repair/Retrofit – Full Permit $456 * $ 456 <br /> _ Repair/Retrofit – Minor Plan Check $ 152 * <br /> Tank Lining $456 * per tank * * lined <br /> Temporary Closure $456 * <br /> Permanent Tank Closure - Removal $ 456 * per tank** removed <br /> Permanent Tank Closure – Closure in Place $456 * per tank * * closed in place <br /> Tank Installation $ 3040 * <br /> ANNUAL CUPA OPERATING PERMITS FEE SUBTOTAL <br /> (FOR NEW INSTALLATIONS ONLY — ALL APPLY) <br /> Hazardous Waste Generator <5 tons/yr $ 249 (if z5 tons/yr, varies) <br /> Hazardous Materials Business Plan ( HMBP) Common $ 81 or Regular $279 NOT COLLECTED IN ADVANCE <br /> HMBP Chemical Fee $ 17 per chemical NOT COLLECTED IN ADVANCE <br /> Underground Storage Tank - Facility VPH $ 1 , 582 <br /> Underground Storage Tank - Tank $250 per tank* * <br /> State Facility Surcharge $49 <br /> State Tank Surcharge $20 per tank * * <br /> CERS Processing Fee $30 NOT COLLECTED IN ADVANCE <br /> ADDITIONAL FEES FEE SUBTOTAL <br /> ' Failure to Obtain a Permit' Penalty $456 <br /> CERS Consultation $ 152 * <br /> New Owner Consultation $ 152 <br /> UNREPORTED TANK FEES SUBTOTAL <br /> (ORIGINAL ANNUAL FEES, LISTED BELOW, WILL BE DOUBLED) <br /> 2015 $ 550 (facility + 1st tank) + $ 139 per tank** after 15' x2 <br /> 2016 $ 583 (facility) + $ 139 per tank** x2 <br /> 2017 $ 641 (facility) + $ 152 per tank* * x2 <br /> 2018 VPH $ 961 or non-VPH $680 (facility) + $228 per tank** x2 <br /> 2019 VPH $ 961 or non-VPH $680 (facility) + $228 per tank** x2 <br /> TOTAL AMOUNT DUE $ 456 <br /> * FEES ARE BASED ON THE $ 152 HOURLY RATE, TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> * * EACH COMPARTMENT IN A SPLIT TANK IS COUNTED AS A SEPARATE TANK. <br /> REVISED 8/20/2020 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 F 209 464 -0138 1 www. sjcehd .coni <br />