Laserfiche WebLink
i <br /> Environmental Health Department <br /> SAN ., JDAWN <br /> _ c o u Aj VII l <br /> FACILITY NAME Chevron FACILITY CONTACT NAME Debbie <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODE <br /> 3775 Tracy Blvd ( 209 832-5006 <br /> CITY 7cli <br /> ATE ZIP CODE # OF TANKS AT SITE <br /> Tracy 95304 <br /> APPLICANT BILLING NAME Elite IV Contractors APPLICANT CONTACT NAME Megan Mitchell <br /> APPLICANT MAILING ADDRESS 2535 Wigwam Dr APPLICANT PHONE # WITH AREA CODE <br /> 9 209 461 -6337 <br /> CITY Stockton STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> Ca 95205 Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> UST FEES = $ 550 2014 2015 UST FEES 2016 UST FEES 2017 VPH UST FEES = 2018 $ <br /> ( Facility+1st = $ 583 = $641 $961 Facility + <br /> Tank) + $130/Tank Facility + Facility + $2281Tank <br /> after 1st $ 139/Tank $ 152ITank _ <br /> Double Wall & 1702 $ <br /> Compliant UST <br /> FEES = $680 <br /> Facilit + $228/Tank <br /> Tank Penalty $ <br /> Assessed for <br /> Unreported Tanks <br /> ( Based on Annual <br /> Permit Fees <br /> TANK SURCHARGE _ $201 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 /> $ <br /> TANK ID # (s) : PLAN CHECK FEE = $3,040 / FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID # (s) : <br /> $ <br /> TANK RETROFIT REPAIR FEE _ $456 / FACILITY (use for monitoring equipment, Cold Starts, EVR upgrades, 456 .00 <br /> Spill buckets, sumps, misc. <br /> PIPING REPAIR FEE _ $456 / FACILITY (use for piping, under-dispenser containment, etc. <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $ 25 $ <br /> CONSULTATION FEE _ $ 1521 HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $ 152 / HOUR $ <br /> SAMPLING INSPECTION FEE _ $ 152/ HOUR $ <br /> FEES ARB ON THE $152 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> TOTAL AMOUNT DUE $ 456. 00 <br /> OFFICE USE ONLY <br /> SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br /> .]k <br /> 1868 E. Hazelton Avenue ( Stockton , California 95205 T 2.09 468-3420 F 209 464-0138 1 www.sjcehd .com <br />