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SAN 10 A U U I N Environmental Health Department <br /> COUNTY <br /> FACILITY NAME FACILITY CONTACT NAME <br /> �-ast and Easy Asimg Naved <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 10878 N Hwy 99 209 931-6154 <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> Stockton CA 95212 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Ronnie Lewis Ronnie Lewis <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 601 1 st Street, Suite B 916 382-4761 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> Sacramento CA cClosure Installation Repair Retrofit Brian Roth 8834817 <br /> ACTIVE FACILITY <br /> UST FEES = $550 2013 2014 2015 UST FEES= 2016 UST FEES= 2017 2018 <br /> (Facility+1st Tank)+ $583 Facility+ $641 Facility <br /> $130/Tank after 1st $139/Tank +$152/Tank $ <br /> Tank Penalty Assessed for $ <br /> Unreported Tanks(Based on <br /> Annual Permit Fees <br /> TANK SURCHARGE=$20 I 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=$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=$1,216/FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <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,under-dispenser containment,ect. <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 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br />