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r SAN JOAQUIN COUNTY <br /> ENv1RONMENTALHEALTH DEPARTMENT <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205-6232 <br /> Telephone:(209)468-3420 Far:(209)468-3433 Web.www.sicehd.com APR 19 2016 <br /> FACILITY NAME FACILITY CONTACT NAME ! Nr'T_ <br /> .I <br /> Vanco Truck and Auto Plaza Mike , <br /> Y-r ei <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 1003 West Charter Way 466-0833 <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> Stockton CA 95201 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Elite IV Contractors KAKw& x Terry Masters <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 2535 Wigwam Dr. 20 461-6337 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> $550 FEE INCLUDES FACILITY FEE+1 TANK 2009 2010 2011 2012 2013 1 2014 <br /> $130 PER TANK AFTER FIRST TANK <br /> $ <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 /> PERMANENTCLOSURE <br /> Removal or Permitted Closure In Place <br /> TANK ID#(s): CLOSURE FEE=$390f 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 Ins actions <br /> TANK ID#(s): PLAN CHECK FEE_$1040/FACILITY Is <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <br /> TANK RETROFIT REPAIR FEE =$390/FACILITY (use for monitoring equipment,cold starts,EVR u $ <br /> °grease' 390.00 <br /> spill buckets,sum s,mist. <br /> PIPING REPAIR FEE_$390/FACILITY use for piping,under-dis rear corltairpnenL act. <br /> MISCELLANEOUS <br /> TRANSFER FEE = $25 $ <br /> CONSULTATION FEE = $130/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $130/HOUR $ <br /> SAMPLING INSPECTION FEE = $130/HOUR $ <br /> FEES ARE BASED ON THE$130 HOURLY RATE. TIME THAT EXCEEDS FEES PAID N1LL BE BILLED TO APPLICANT. <br /> TOTAL AMOUNT DUE $ 390.0 <br /> OFFICE USE ONLY <br /> SERVICE REQUEST p I FACILITY 10 1 AMOUNT RECEIVED I CHECK p I RECEIVED BY DATE RECEIVED <br /> EH 23 032(REVISED 08-04-14) <br />