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• PgUlp <br /> z; Z COUNTY OF SAN JOAQUIN ACCOUNT NUMBER <br /> m: < OFFICE OF EMERGENCY SERVICE a( a(o <br /> ROOM 401,COURTHOUSE <br /> i 222 EAST WEBER AVENUE <br /> °4<jp o `P STOCKTON, CALIFORNIA 95202 <br /> BUSINESS EMERGENCY PLAN FEES <br /> BUSINESS NAME BUSINESS PHONE NUMBER <br /> BUSINESS CONTACT NAME � <br /> W/Z,Z,/,0E9. -�` <br /> BUSINESS ADDRESS CITY STATE ZIP <br /> Al 77 klt gLEe cZ"4 2n2 ns- <br /> BUSINESS <br /> sBUSINESS EMERGENCY PLAN TYPE: LONG /$240.00 FEE PLUS rHORT /$6000 FEE PLUS ` <br /> ❑ FORM `$15.00 PER HAZARDOUS MATERIAL L' FORM `$10.00 PER HAZARDOUS MATERIAL/ <br /> NUMBER OF HAZARDOUS MATERIALS: <br /> AMOUNT DUE • • 9 <br /> 066.on + x D o0 - $/o©. Da <br /> FEE NUMBER OF MATERIAL FEES <br /> HAZARDOUS MATERIALS <br /> DATE DUE: UR REMITTANCE — <br /> elwl L ••Y MUST BE RETURNED VVITH • <br /> S. <br /> EXAMPLES <br /> CALCULATIONS: <br /> Long Form Emergency Business Plans PAID <br /> $240.00 Administrative Fee <br /> + $15.00/Hazardous 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 /> + $10.00/Hazardous 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 /> CSJIOES-01 <br /> RETURN WITH YOUR REMITTANCE / V <br />