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OFFICE USE ONLY <br />SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED RECEIVED BY DATE RECEIVED CHECK # <br />EH 23 032 (REVISED 04-22 15) <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E. Haze1ton Ave., Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjcehd.com <br /> <br />ED <br /> <br />MAY 3 0 2018 <br />FACILITY NAME FACILITY CONTACT NAME <br />JD Service Stations JWIRONMENTAI Jawinder Singh HEAI,TH DE:PAM-ME FACILITY ADDRESS SITE PHONE # WITH AREA CODE <br />9015 W Walnut Grove Rd ( 209 ) 734-8993 <br />CITY STATE ZIP CODE # OF TANKS AT SITE <br />Thornton CA 95686 <br />APPLICANT BILLING NAME APPLICANT CONTACT NAME <br />Elite IV Contractors Megan M <br />APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br />2535 Wigwam Dr ( 209 ) 461-6337 <br />CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br />Stockton CA 95205 Closure Installation Repair Retrofit <br />ACTIVE FACILITY <br />$550 FEE INCLUDES FACILITY FEE + 1 TANK <br />$130 PER TANK AFTER FIRST TANK <br />2010 2011 2012 2013 2014 2015 <br />$ <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 />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # (s): CLOSURE FEE = $390! TANK # TANKS X $390 = $ <br /> <br />(Plan Review and Inspections) <br /> <br />TANK ID #(s) : TEMPORARY CLOSURE FEE = $390 / FACILITY <br /> <br />INSTALLATION PLAN CHECK <br />(Plan Check and Construction Inspections) <br /> <br />TANK ID # (s) : PLAN CHECK FEE = $1040! FACILITY <br /> <br />REPAIR PLAN CHECK <br />TANK ID # (s) : <br />TANK RETROFIT REPAIR FEE = $390 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, <br />spill buckets, sumps, misc.) <br />$ <br />456.00 <br />PIPING REPAIR FEE = $390/ FACILITY (use for piping, under-dispenser containment, ect.) $ <br />MISCELLANEOUS <br />TRANSFER FEE = $ 25 $ <br />CONSULTATION FEE = $ 130/ HOUR $ <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 130/ HOUR $ <br />SAMPLING INSPECTION FEE = $ 130/ HOUR $ <br />.TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br />TOTAL AMOUNT DUE $ 456.00 <br />NT