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SAN , ,1oAQU ( N Environ n <br /> ---- COUNTY_ <br /> 41 , <br /> 2 2 ,2021 <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Quik Stop Markets # 144 u <br /> FACILITY ADDRESS SITE PHONE # WITH AREA CODtN /'p®N LTH <br /> 7272 West Lane ( 209 ) 95M812 MDAPTMEN1V Y f� T <br /> CITY STATE ZIP CODE # OFT T I E <br /> Stockton CA 95210 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 /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # <br /> Stockton CA 95205 1 Closure Installation Repair Retrofit 1001331 XHatmat <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 + $228Prank <br /> after 1st $139/Tank $152/1rank <br /> Double Wali & 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 ! 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 /> TANK ID # (s) : TEMPORARY CLOSURE FEE _ $456 / FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> E TANK ID # (s) : PLAN CHECK FEE _ $3,040 / FACILITY $ <br /> E <br /> REPAIR PLAN CHECK <br /> TANK ID # (s) : <br /> TANK RETROFIT REPAIR FEE _ $456 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades , $ <br /> Spill buckets, sumps, misc. 456 <br /> PIPING REPAIR FEE _ $456 / FACILITY use forpiping, underAls enser containment, etc.) $ <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $ 25 $ <br /> CONSULTATION FEE _ $ 152/ HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $ 152 ! HOUR $ <br /> SAMPLING INSPECTION FEE _ $ 1521 HOUR $ <br /> FEES ARE BASED ON THE $152 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT, <br /> TOTAL AMOUNT DUE $ 456 <br /> OFFICE USE ONLY <br /> SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br /> if <br /> i <br />