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• SAN JOAQUIN COUNTY • <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone.-(209)468-3420 Far:(209)468-3433 Web:www.sisov.ore'ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> 3hell Oil I o rr s <br /> FACILITYADDRESS SITE HONE#WITH AREA CODE <br /> 351n IY <br /> CRYI STATE ZIP CODE I #OF TANKS AT SITE <br /> Ittockton ICA 2H II <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> r l s - <br /> APPLICANT MAILING ADDRESS APPLICANT PtHONE WIToH AREA CODE <br /> 21 I 119 920 8212 <br /> CITY STATE I 21P CODE CIRCLE WORK T DONE I CONTRACTOR ICC# <br /> Cj 0 Closure Installation Re ai Retrofit <br /> ACTIVE FACILITY <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK(2007-2008) 20071 2008 2009 2010 1 011 1 2012 <br /> $550 FEE INCLUDES FACILITY FEE+1 TANK(20092012) <br /> $125 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 COPA PROGRAM=$49.001 FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID#(a): CLOSURE FEE_$375/TANK #TANKS X$375= $ <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID#(a); TEMPORARY CLOSURE FEE=$375/FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Consimclion Inspections) <br /> TANK ID#(s): PLAN CHECK FEE=$1000/FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): 510 <br /> TANK RETROFIT REPAIR FEE _$375/FACILITY (use for monitoring equipment,cold starts,EVR upgrades, <br /> spill buckets,sumps,misc. <br /> PIPING REPAIR FEE _$375/FACILITY use for piping.under-0Is enser containment,act $ <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $25 $ <br /> CONSULTATION FEE = $1251 HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $1251 HOUR 19 2014 $ <br /> SAMPLING INSPECTION FEE = $1251 HOUR g��p���q�a�m�•L3 $ <br /> ALL FEES ARE BASED ON THE$125 HOURLY RATE. TIME THAT EXCEEDS IN IVI CI Vt1 y1L 1 11�AUH <br /> TOTAL AMOUNT DUE DEPARTMENT $ <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK# I RECEIVED BY I DATE RECEIVED <br /> EH 23 032(REVISED 04/13112 by KF) <br />