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Environmental Health Department <br /> SHAUN <br /> - -- COUNTY _---- . <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Quik Stop Markets # 132 <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODE <br /> 3555 W Hammer Lane ( 209 ) 951 -3195 <br /> CITY STATE ZIP CODE # OF TANKS AT SITE <br /> Stockton CA 95209 3 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Elite IV Contractors Deborah Jones <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> 2535 Wigwam Drive 209 461 -6337 <br /> CITYSTATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> Stockton C 995205 Closure Installation Repair Retrofit 1001331 A-Hazmat <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) + $1301Tank Facility + Facility + $228/Tank <br /> after 1st $139/Tank $1521Tank <br /> Double Wail & 1702 $ <br /> Compliant UST <br /> FEES = $680 <br /> Facility + $2281Tank <br /> Tank Penalty $ <br /> Assessed for <br /> Unreported Tanks <br /> (Based on Annual <br /> Permit Fees <br /> TANK SURCHARGE = $20 I 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 = $3,040 / 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, sum s, misc. <br /> PIPING REPAIR FEE _ $456 / FACILITY use for p1pIng, under-dispenser containment, etc. <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $ 25 $ <br /> CONSULTATION FEE _ $ 1521 HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $ 152 f HOUR $ <br /> SAMPLING INSPECTION FEE _ $ 152/ HOUR $ <br /> FEES ARE BASED ON THE f152 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> TOTAL AMOUNT DUE $ 456 <br /> OFFICE USE ONLY <br /> SERVICE REQUEST # I FACILITY ID AMOUNT RECEIVED 77 CHECK # RECEIVED BY I DATE RECEIVED <br /> 1868 E. Hazelton Avenue I Stockton , California 952051 T 209 468-3420 I F 209464-0138 1 www. sjcehd .com <br />