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. <br /> a SAN >� OA Q U I N Environmental Health Department <br /> COUNTY --- <br /> C� rtrtrtrzr> ss grows here-, . <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Tiwana Gas & Food Paul Tiwana <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODE <br /> 1210 E Hammer Ln ( 209 ) 715-0124 <br /> CITY STATE ZIP CODE # OF TANKS AT SITE <br /> Stockton <br /> CA 95210 <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 /> 209 1 461 -6337 <br /> CITY Stockton STaATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> C <br /> 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 let $ 139/Tank $ 1521Tank <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 /> 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 /> TANK ID # (s) : PLAN CHECK FEE = $3, 040 / FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID # (s) : <br /> TANK RETROFIT REPAIR FEE _ $456 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades , 456. 00 <br /> S ill buckets , sumps mise. <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 _ $ 1521 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 $ 456 .00 <br /> OFFICE USE ONLY <br /> SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK H RECEIVED BY DATE RECEIVED <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sjcehd .com <br />