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SAN JOAQUIN COL"1TY RECEIVED <br />ENVIRONMENTALHEALTH DEPARTMENT <br />1868 E. Hazelton Ave., Stoclaon, CA 95205-6232 NOV <br />2 O, <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjcehdxom <br />FACILITY NAME <br />FACILITY CONTACT NAME <br />Residence of Rodney D. Gaede and Linda D. Gaede <br />Rodney D. Gaede ENVIRON MENIAEF <br />FACILITY ADDRESS <br />SITE PHONE # WITH AREA CODE <br />8476 E. Kettlentan Lane <br />209 639-7012 <br />CITY I STATE <br />TIP CODE # OF TANKS AT SITE <br />Lodi I CA <br />95240 One <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />Terry D. Hamilton <br />Terry D. Hamilton <br />APPLICANT MAILING A013RESS <br />APPLICANT PHONE #WITH AREA CODE <br />1502 Westbrook Court <br />209 404-7700 <br />CITY STATE <br />ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br />Modesto UAClosure <br />Installation Re air Retrofit <br />EALTH <br />ACTIVE FACILITY <br />TANK ID # s <br />(As of 811/16) $583 FACILITY FEE + $139 PER TANK <br />2011 <br />2012 <br />2013 <br />2014 <br />2015 2016 <br />Facility Fee NO LONGER INCLUDES FIRST TANK <br />$ <br />PIPING REPAIR FEE = S4171 FACILITY use for piping, under -dispenser containment. ect. <br />(2011 -Aug 1, 2016) 5550 FEE SNCLUDES FACILITY FEE + 1 TANK <br />$ <br />$130 PER TANK AFTER FIRST TANK <br />TANK PENALTY ASSESSED <br />TANK SURCHARGE = $15 / TANK <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$35.00! FACILITY <br />$ <br />PERMANENT CLOSURE <br />(Removal or Permitted Closure in Place <br />TANK ID # s <br />CLOSURE FEE = $4171 TANK <br />1 # TANKS X $417 = <br />TEMPORARY CLOSURE <br />Plan Review and Ins eckiorzs} <br />TANK TD # (s) : <br />TE MPORARY CLOSURE FEE _ $417 !FACILITY <br />Check <br />TANK I D # <br />PLAN CHECK FEE = $1112 1 FACILITY <br />REPAIR PLAN CHECK <br />TANK ID#(s): <br />$ <br />CONSULTATION FEE = S 1391 HOUR <br />$ <br />TANK RETROFIT REPAIR FEE = $417 1 FACILITY (use for monitoring equipment, cold starts, EVR upgrades, <br />$ <br />spill buckets, sumps, mise. <br />$ <br />PIPING REPAIR FEE = S4171 FACILITY use for piping, under -dispenser containment. ect. <br />MISCELLANEOUS <br />TRANSFER FEE = $25 <br />$ <br />CONSULTATION FEE = S 1391 HOUR <br />$ <br />UNAUTHORIZED RELEASE EVALUATION FEE = S 1391 HOUR <br />$ <br />SAMPLING INSPECTION FEE _ $ 139! HOUR <br />$ <br />FEES ARE BASED ON THE $139 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br />TOTAL AMOUNT DUE $ 417.00 <br />