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SAN << U A Q U i N nvironmenAtI 110 ' rth D epArtmen : _ <br /> jj <br /> �x <br /> C0UN _f' Y--- <br /> ; ( ( . tcG1 /i <' S5 (tr0t`: s j1E) rc.> . f ) 1 � 1 ; <br /> FACILITY NAME French Camp 76 FACILITY CONTACT NAME Sunny <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODEr = ( � f l /� } "s t a` <br /> 5777 French Camp Rd ( 209 ) 983-4781 y' I & j <br /> CITY STATE ZIP CODE # OF TANKS AT SiTE <br /> Stockton CA 95206 <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 STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> Stockton Ca 95205 <br /> 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 $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 I 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 # (a) : CLOSURE FEE = $456 / TANK # TANKS X $456 = $ <br /> TEMPORARY CLOSURE <br /> Pian Review and Inspections) <br /> TANK ID # (s) : TEMPORARY CLOSURE FEE = $456 / FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Ins ecti ns <br /> TANK ID # (a) : PLAN CHECK FEE = $30040 / FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID # (s) : <br /> TANK RETROFIT REPAIR FEE _ $456 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, $ <br /> S ill buckets, sum s, misc. N 152.00 <br /> PIPING REPAIR FEE = $456 / FACILITY use for piping, under-dispenser containment, etc. $ <br /> MISCELLANEOUS <br /> TRANSFER FEE = $ 25 $ <br /> CONSULTATION FEE _ $ 152/ 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 $ 152.00 <br /> OFFICE USE ONLY <br /> SERVICE REQUEST # I FACILITY ID AMOUNT RECEIVED CHECK 4 RECEIVED BY I DATE RECEIVED <br /> 1868 E . Hazelton Avenue Stockton , California 952051 T 209468-34201 F 209464-0138 1 www,sjcehd .com <br />