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PCU1! • s <br /> �o. j.ca` COUNTY OF SAN JOAQ(1[IY ACCOUNT NUMBER <br /> r.' y <br /> OFFICE OF EMERGENCY SERVICE <br /> ROOM 401,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> c4�laoaa`P STOCKTON, CALIFORNIA 95202 <br /> BUSINESS EMERGENCY PLAN FEES <br /> BUSINESS NAME BUSINESS PHONE NUMBER <br /> TW Sl1PPLY TOOL FenTL IN( <br /> BUSINESS,WTACi-NAME)STo <br /> BUSL�f.AFCfIi71G1'•.1J1J - CITY ,.r;T� STATE ZIP <br /> LONG $240.90 FEE PLUS \ SHORT /$60.00 FEE PLUS <br /> BUSINESS EMERGENCY PLAN TYPE: ❑ FORM ($15.90 PER HAZARDOUS MATERIAL1 ❑ FORM `$1000 PER HAZARDOUS MATERIAL) <br /> NUMBER OF HAZARDOUS MATERIALS: 4 <br /> AMOUNT DUE <br /> + ( 4 X : 10.00 = $100 <br /> FEE NUMBER OF MATERIAL FEES <br /> HAZARDOUS MATERIALS <br /> WHITE COPY MUST BE RETURNED WITH YOUR REMITTANCE — <br /> DATE DUE: KE EP YELLOW • ' • ' YOUR RECORDS. <br /> EXAMPLES t.0#4 <br /> CALCULATIONS: <br /> Long Form Emergency Business Plans <br /> $240.00 Administrative Fee <br /> + $15.00IHazardous Material <br /> (EXAMPLE: 1 Long Form Emergency Business Plan with 3 Hazardous <br /> Materials = $240.00 + (3 x $15.00) = $285.00) <br /> Short Form Emergency Business Plans <br /> $60.00 Administrative Fee <br /> + $10.00IHazardous Material <br /> (EXAMPLE: 1 Short Form Emergency Business Plan with 3 Hazardous <br /> Materials = $60.00 + (3 x $10.00) = $90.00) <br /> If you have any questions or wish to discuss the calculations, please <br /> call 944-2116 to make an appointment. <br /> Thank you for your cooperation. <br /> OSJIOES-01 <br /> FILE COPY. <br />