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SAN JOAQUIN COUNTY RECEIVEE ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. Hazelton Ave., Stockton, CA 95205-6232 SEP 2 6 2016 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sicehd.com FACILITY NAME FACILITY CONTACT NAME ENViRONMtN I/ 7 -Eleven #19976 DEPARTM FACILITY ADDRESS 1399 N Main Street SITE PHONE # WITH AREA CODE CITY STATE ZIP CODE # OF TANKS AT SITE Manteca CA 95336 1 2 APPLICANT BILLING NAME Walton Engineering, Inc. APPLICANT CONTACT NAME Veronica Freitas APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE P.O. Box 1025 916 373-1166 CITY STATE I ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # We. -,t Sacromento CA 1 95691 Closure Installation Re air Retrofit L HEALTH .NT ACTIVE FACILITY TANK ID # (s): (As of 8/1/16) $583 FACILITY FEE + $139 PER TANK 2011 2012 2013 2014 2015 2016 $ Facility Fee NO LONGER INCLUDES FIRST TANK PIPING REPAIR FEE = $417 / FACILITY use for piping, under -dispenser containment, ect. (2011 -Aug 1, 2016) $550 FEE INCLUDES FACILITY FEE + 1 TANK $ $130 PER TANK AFTER FIRST TANK $ TANK PENALTY ASSESSED $ TANK SURCHARGE = $15 /TANK $ STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$35.00/ FACILITY PERMANENT CLOSURE Removal or Permitted Closure in Place TANK ID # (s): CLOSURE FEE = $417 / TANK # TANKS X $417 = TEMPORARY CLOSURE Plan Review and Inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $417 / FACILITY NSTALLATION PLAN CHECK Plan Check and Construction Ir TANK ID # (s) : I PLAN CHECK FEE = $1112 / FACILITY $ I REPAIR PLAN CHECK TANK ID # (s) : $ $ TANK RETROFIT REPAIR FEE = $417 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, UNAUTHORIZED RELEASE EVALUATION FEE = $ 139 / HOUR spill buckets, sumps, misc.) 417 $ $ PIPING REPAIR FEE = $417 / FACILITY use for piping, under -dispenser containment, ect. MISCELLANEOUS TRANSFER FEE _ $ 25 $ CONSULTATION FEE = $ 139/ HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 139 / HOUR $ SAMPLING INSPECTION FEE _ $ 139/ HOUR $ ..-La �..� r�.aw v.• .,.� .p.aa „vain. nw, �. nn� ne. CAIiCCUJ r-0 rMIU VVML DC DILLCU 1 V Arr LIli A1N I. TOTAL AMOUNT DUE $ 417 OFFICE USE ONLY SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED EH 23 032 (REVISED 07-15-2016)