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ACCOUNT NUMBER. <br /> k- CINTY OF SAN JOAQUIN <br /> e. ?� OFFICE OF EMERGENCY SERVICE <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> �C/FORM <br /> BUSINESS EMERGENCY PLAN FEES <br /> - BUSINESS PHONE NUMBER <br /> BUSINESS NAME <br /> BUSINESS OONT,ACT NAME CITY^; STATE�;,j{ <br /> -__ °{ �'(� <br /> SUSINEWAPDRESS \ <br /> ��yhyf QNG �$240.00FEEPLUS SHORT ($100.00 PERFEEHPAZARDOUSMATERIAL/ <br /> BUSINESS EMERGENCY PLAN TYPE: <br /> L�'X ORM $15.00 PER HAZARDOUS MATERIAL � FORM ` <br /> 6 <br /> NUMBER OF HAZARDOUS MATERIALS: �— – • • <br /> AMOUNT DUE 6 = 15.00 ) _ ---------------- <br /> $240 00 x <br /> -� NUMBER OF MATERIAL FEES <br /> FEE HAZARDOUS MATERIALS <br /> DATE DUE: <br /> EXAMPLES <br /> CALCULATIONS: <br /> Long Form Emer enc Business Plans <br /> $240.00 Administrative Fee <br /> + $15.00IHazardous Material <br /> (EXAMPLE: <br /> 1Long Form Ey B siness)Plan with 3 Hazardous <br /> Materials $24000 + (3 x $1500) <br /> Short Form Emer enc Business Plans <br /> $60.00 Administrative Fee <br /> + $10.00IHazardous Material Business Plan with 3 Hazardous <br /> (EXAMPLE: 1 Short Form Emergency <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 468-3969 to make an appointment. <br /> Thank you for your cooperation. <br /> CSJIOES-01 FILE COPY <br />