Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.or /g ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> 1.��� ciFtZ Ko 14'� Z`,¢.aa ltil (,- <br /> FACILITY <br /> omFACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 15--2-( Fil cwuz, r4-� s3 —V 7 4-y <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> 54--'Cvoo" CA `JS-2o C. 1 <br /> APPLICANT BILLING NAME (( APPLICANT CONTACT NAME <br /> (la(( hhG�e tw.� It nt pu l k"— 0 <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> I'isK e4 rT-r'v`k wpsr Ck"J*- zo 5;s3 S-72 3 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> 5{0� ��j �, (�►4- �j �ZoL; Closure Installation QRRetrofit s—Z�c-<,>3 Z. <br /> ACTIVE FACILITY <br /> 2005 2006 2007 2008 2009 2010 <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK(2005-2007) <br /> $550 FEE INCLUDES FACILITY FEE+1 TANK(2008-2010) $ <br /> $125 PER TANK AFTER FIRST TANK <br /> TANK PENALTY ASSESSED <br /> $ <br /> TANK SURCHARGE=$15/TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$49.00/FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID#(s): CLOSURE FEE=$366/TANK #TANKS X$366= <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID#(s): TEMPORARY CLOSURE FEE=$366/FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> $ <br /> TANK ID#(s): PLAN CHECK FEE=$976/FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <br /> TANK RETROFIT REPAIR FEE =$366/FACILITY (use for monitoring equipment,cold stars,EVR upgrades, <br /> spill buckets,sumps,misc.)kS J <br /> PIPING REPAIR FEE =$366/FACILITY use for piping,under-dispenser containment,ect. <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $25 <br /> $ <br /> CONSULTATION FEE _ $122/HOUR <br /> $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $122/HOUR <br /> SAMPLING INSPECTION FEE _ $122/HOUR <br /> ALL FEES ARE BASED ON THE$122 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED I CHECK# RECEIVED BY GATE RECEIVED <br /> SR <br /> EH 23 032(REVISED 07/21/10) <br />