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RFT F <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT JAN 1) b! 1018 <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205-6232 <br /> 7elephotre:(209)468-3420 Fns.(209)468-3433 Web:Www.s ceh c <br /> :\ i(�I�JNIEN`I'I11 1IE/\LIII <br /> FACILITY NAME FACILITY CONTACT NAME PPPAP <br /> Vanco Mike Popari <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 1033 W Charter Way 916 396-1665 <br /> CITY I STATE ZIP CODE #OF TANKS AT SITE <br /> Stockton CA 95206 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Elite IV Contractors Me an Mitchell <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 2535 Wigwam Dr -(209 ) 461-6337 <br /> CITY STATE I ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> 2010 2011 2012 2013 2014 2015 <br /> $550 FEE INCLUDES FACILITY FEE+1 TANK <br /> $130 PER TANK AFTER FIRST TANK $ <br /> TANK PENALTY ASSESSED <br /> TANK SURCHARGE=$15/TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$35.00/FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID#(s): CLOSURE FEF=$390/TANK #TANKS X$390= <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID#(s): TEMPORARY CLOSURE FEE=$390/FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> TANK ID#(s): PLAN CHECK FEE=$1040/FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <br /> TANK RETROFIT REPAIR FEE =$390/FACILITY (use for monitoring equipment,cold starts,EVR upgrades, $ <br /> spill buckets,sumps,misc.)456.00 <br /> PIPING REPAIR FEE=$3901 FACILITY use for piping,under-dispenser containment,act. <br /> MISCELLANEOUS <br /> TRANSFER FEE = $25 $ <br /> CONSULTATION FEE = $1301 HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $1301 HOUR $ <br /> SAMPLING INSPECTION FEE = $130/HOUR $ <br /> FEES ARE BASED ON THE$130 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> TOTAL AMOUNT DUE $456.0 <br /> OFFICE USE ONLY <br /> [SERVICE REDDEST# FACILITY ID I AMOUNT RECEIVED CHECK# I RECEIVED BY I DATE RECEIVED <br /> CW /DCIf1Q.n RA_19_1R1 <br />