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SAN JOAQUIN COUNTY RECEIVED <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E . Hazelton Ave . , Stockton, CA 95205 -6232 <br /> Telephone: (209) 468 -3420 Fax: (209) 468 -3433 Web: www. sicehd . com SEP 2 8 2016 <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Spaulding Trust Property Spaulding Trust Property C/O Will MVINONMENTAL 1EALTH <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODE DEPARTMEW <br /> 540 North ElDorado Street ( 707 812- 1426 <br /> CITY STATE ZIP CODE # OF TANKS AT SITE <br /> Stockton CA 95203 one <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Spaulding Trust Property C/O Will Namnath Will Namnath <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> 1434 Third Street , Suite D 707 812- 1426 <br /> CITY Napa STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> 94581 Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> (As of 8/1 /16) $ 583 FACILITY FEE + $ 139 PER TANK 2011 2012 2013 2014 2015 2016 <br /> Facility Fee NO LONGER INCLUDES FIRST TANK <br /> (2011 -Aug 1 , 2016) $ 550 FEE INCLUDES FACILITY FEE + 1 TANK $ <br /> $ 130 PER TANK AFTER FIRST TANK <br /> TANK PENALTY ASSESSED <br /> TANK SURCHARGE = $ 15 / TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM = $ 35. 00/ FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID # (s) : CLOSURE FEE = $417 / TANK 1 # TANKS X $417 = $ 417 . 00 <br /> TEMPORARY CLOSURE <br /> (Plan Review and Inspections <br /> TANK ID # (s) : TEMPORARY CLOSURE FEE = $417 / FACILITY <br /> INSTALLATION PLAN CHECK <br /> Pian Check and Construction Inspections) <br /> TANK ID # (s) : PLAN CHECK FEE = $ 1112 / FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID # (s) : <br /> TANK RETROFIT REPAIR FEE _ $417 / FACILITY (use for monitoring equipment, cold starts , EVR upgrades , $ <br /> spill buckets , sumps , mise) <br /> PIPING REPAIR FEE = $417 / FACILITY (use for piping , under-dispenser containment, ect) <br /> MISCELLANEOUS <br /> TRANSFER FEE = $ 25 $ <br /> CONSULTATION FEE _ $ 139/ HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $ 139 / HOUR $ <br /> SAMPLING INSPECTION FEE _ $ 139/ HOUR $ <br /> FEES ARE BASED ON THE $139 HOURLY RATE . TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> TOTAL AMOUNT DUE $ 417 <br /> OFFICE USE ONLY <br /> SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br /> EH 23 032 (REVISED 07-15-2016) <br />