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SAN J O A Q U I N Environmental Health Department <br /> COU NTY - <br /> � 1' CCJtll B55 (� rC. 4'iJ fl C' I' c . <br /> FACILITY NAME <br /> Chevron 494275 FACILITY CONTACT NAME <br /> Chevron <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODE <br /> 2905 West Benjamin Holt Dr <br /> CITY STATE ZIP CODE # OF TANKS AT SITE <br /> Stockton CA 95207 2 <br /> APPLICANT BILLING NAME Wayne Perry Inc APPLICANT CONTACT NAME Ton Baiad <br /> Y Y <br /> APPLICANT MAILING ADDRESS 30 Main Ave S TE 5 APPLICANT PHONE # WITH AREA CODE <br /> ( 916.- 646 - 9680 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> Sacramento CA 958382 <br /> Closure Installation kRepai Retrofit Z.. S Z <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 + $228/Tank <br /> after 1st $ 139/Tank $152/Tank <br /> Double Wall & 1702 $ <br /> Compliant UST <br /> FEES = $680 <br /> Facility + $228/Tank <br /> Tank Penalty $ <br /> Assessed for <br /> Unreported Tanks <br /> (Based on Annual <br /> Permit Fees <br /> TANK SURCHARGE _ $20 / TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM = $49 .00/ FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID # (s) : CLOSURE FEE = $456 / TANK # TANKS X $456 = <br /> $ <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> $ <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 = $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 , 4 5 6 <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 ARE BASED ON THE $152 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT, <br /> TOTAL AMOUNT DUE $ S <br /> OFFICE USE ONLY <br /> SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468-3420 F 209 464-0138 1 www. sjcehd . com <br />