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SAN JOAQUIN Environmental Health Department <br /> Ile - C0UNJ- Y - <br /> �. <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Costco Wholesale # 1031 Warehouse Manager <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODE <br /> 2440 Daniels Street ( 209 ) 825-8200 <br /> CITY STATE ZIP CODE # OF TANKS AT SITE <br /> Manteca CA 95337 3 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Costco Wholesale c/o Barghausen Consulting Engineers , Inc . Alexia Inigues <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> 18215 72nd Avenue South 425 251 222 <br /> CITY Kent STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> WA 98032 ClosureInstallation Re air 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 $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 I 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 <br /> Spill buckets sums misc. <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 /> $ <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 T 71 <br /> $ 456 <br /> OFFICE USE ONLY <br /> SERVICE REQUEST # I FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY I DATE RECEIVED <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 F 209 464 -0138 1 www . sjcehd . coni <br />