Laserfiche WebLink
•*1a� 1:5 2006 4: 41 PM Wr -tern States Contract i n 480-,'91-5847 r . 2 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue 3`d Floor, Stockton, CA 95202-2708 <br />Telephone: (2.09) 468-3420 Fax (P floor): (209) 468-3433 Web: <br />FACIUn.' NAME <br />APPLIC:ANT ADDRESS <br />FACILITY CONTACT NAME <br />/MAILING <br />CITY STATE ZIP CODE <br />E LA•zAL �pQ1^ '3 <br />CIRCLE WORK TO BE DONE CONI'RiZTOR I1..0 $1 <br />Closure nstallatio Papa*, Retta l'. <br />TANK FENALTY ASSESSED <br />FACIL11 Y ADDRESS <br />Plarl R-viewarnd Inspections) <br />SITE PHONE # VVITH AREA CODE <br />kCAbS'S-Titk1-f,i"C-f <br />Viii' <br />�IEZT d4'JA.�t..c�(� <br />STATE <br />ZIP CODE <br />T OF TANK:! AT SCFE <br />rlpct�cT� <br />L <br />cA <br />4`521,9 <br />_ � <br />APPLICANT BILLING NAME APPLICANT CONTACT NAME <br />jil.e1C_ k" 'Eyo -TMM M► <br />APPLIC:ANT ADDRESS <br />APPLICANT PHONE* AATH AREA CODE <br />/MAILING <br />CITY STATE ZIP CODE <br />E LA•zAL �pQ1^ '3 <br />CIRCLE WORK TO BE DONE CONI'RiZTOR I1..0 $1 <br />Closure nstallatio Papa*, Retta l'. <br />ACTIVE: FACILITY <br />Removal or Permitted Closure in Place) <br />2000 2001 2002 2003 <br />$500 FI -E INCLUDES FACILITY FEE + 1 TANK <br />$12'., PER TANK AFTER FIRST TANK I <br />2004 ! 2005 <br />— <br />$ <br />TANK FENALTY ASSESSED <br />_ <br />Plarl R-viewarnd Inspections) <br />I TANK SURCHARGE -$1aPTANK <br />COVSULTATiON FEE _ $ 931 HOUR _ <br />�j STATE SJRCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY INA COPA PROGRW=$.24.00! FACILITY <br />PCRMA,NENTT CLOSURE <br />Removal or Permitted Closure in Place) <br />TAN.' I D 4 (s) <br />TANK ID :k L CLOSURE FEE F $2791 TANK <br />;i'• TANKS X $279 =_ <br />TE APCRARY CLOSURE <br />Plarl R-viewarnd Inspections) <br />TAN,( ID I (s) : TEMPORARY CLOSURE FEE _ $279 / FACULTY _ <br />n Check and Construcllon <br />.K FEE = 5744 / FAC:II_:TY <br />REP41Ft PLAN CHECK u� <br />TAN.' I D 4 (s) <br />TAN': RETROFIT REPAIR FIFE - 9)279 /FACILITY (use for rnonRoring equipment, spIq buckets, tank Sumps, Irllsc.)_ <br />T RFi'JS;: ER FEE _ $ 20 <br />$ <br />PIPPING REPAIR FEE = $279 'FACILITY (use for piping, under -dispenser oontalnmen;. ed.) <br />COVSULTATiON FEE _ $ 931 HOUR _ <br />MISCELLANEOUS — <br />T RFi'JS;: ER FEE _ $ 20 <br />$ <br />COVSULTATiON FEE _ $ 931 HOUR _ <br />$ <br />UNAJTAORiZED RELEASE EVALUATION FEE _ $ 931 HOUR <br />SAMPLING INSPECTION FEE S 93/ DOUR _ <br />ALL (TEES ARE BASED ON THE $92 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLE D TO APPLICANT. <br />n�pon = <br />LI -SE ONLY <br />SERVICE. P,EQUEST # FACILITY ID AMOUNT P,ECEIVED CHECK 0 RECEIVVni REGEIJL_7 <br />Ste. R.w <br />EH 2:1 022 ;REVISED 02122!06) <br />