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JOAEnvironmental Health Department <br /> SANICOUNTY --- <br /> FACILITY ^NAME FACILITY CONTACEAREA <br /> ony Singh <br /> WWI <br /> FACILITY ADDRESS SITE PHONE It WITHE <br /> S �) � ( {/' � ( 209 ) 461 -6 <br /> CITY <br /> STATE ZIP CODE # OF TANKS AT SITE <br /> CA I e?,�-Z)o <br /> APPLICANT BILLING NAME Elite IV Contractors APPLICANT CONTACT NAME Megan Mitchell <br /> APPLICANT MAILING ADDRESS 2535 Wigwam Df APPLICANT PHONE # WITH AREA CODE <br /> 209 461 -6337 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> Stockton Ca 95205 Closure Installation Repair Retrofit <br /> I ACTIVE FACILITY <br /> UST FEES = $ 550 2014 2015 UST FEES 2016 UST FEES 2017 VPH UST FEES = 2018 $ <br /> = $583 = $641 $961 Facility + <br /> (Facility+ 1st Facility + Facility + $228JTank <br /> Tank) + $130/Tank y <br /> I after 1st $139/Tank $152ITank Double Wall & 1702 $ <br />` Compliant UST <br /> i <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 _ $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 /> TEMPORARY CLOSURE FEE _ $456 / FACILITY <br /> TANK ID # (s) : <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Ins ections $ <br /> TANK ID # (s) : PLAN CHECK FEE = $30040 / FACILITY <br /> REPAIR PLAN CHECK <br /> TANK WTID # (s) : $ <br /> TANK RETROFIT REPAIR FEE _ $456 / FACILITY (use form it buying equipment, <br /> s ms <br /> m n ,csold starts, EVR upgrades, 456 .00 <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 f $ 1 <br /> HOUR <br /> FEES ARE BASED ON THE $152 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> TOTAL AMOUNT DUE <br /> OFFICE USE ONLY RECEIVED 8Y DATE RECEIVED <br /> SERVICE REQUEST # FACILITY ID <br /> AMOUNTRE CHECK # <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468-3420 F 209 464-0138 ( www.sjcelid .com <br />