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< ' ,� QQ U I Environmental Health p rtrt� f s <br /> �. <br /> -- COUNTY r <br /> C� rcc? trTe5S grow+ s hare , <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Kludt And Sons Steve Kiudt <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODE <br /> 1126 E Pine St 209 466-8969 r nt LTH <br /> CITY STATE ZIP CODE A KS A ITE <br /> Lodi IT <br /> CA 95241 DE � AFI a � � <br /> APPLICANT BILLING NAME Elite IV Contractors APPLICANT CONTACT NAME Megan M <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> 2535 Wigwam Dr <br /> CITY STaATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> Stockton <br /> C 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 + $228/Tank <br /> after 1st $ 1391Tank $152/Tank <br /> Double Wail & 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 = $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 /> $ <br /> TANK ID # (s) : PLAN CHECK FEE _ $3,0401 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, underdis enser 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 5152 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> TOTAL AMOUNT DUE $ <br /> OFFICE USE ONLY <br /> SERVICE REQUEST # I FACILITY ID AMOUNT RECEIVED I CHECK N I RECEIVED BY I DATE RECEIVED <br /> 1868 E . Hazelton Avenue ( Stockton , California 95205 T 209 46&3420 F 209 464-0138 1 www.sjcehd .com <br />