COMPLIANCE INFO 2007-2012 - Laserfiche WebLink

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SAN JOAQUIN COUNTY • ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street,Stockton,CA 95202-3029 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www sigov.orwehd FACILITY NAME FACILITY CONTACT NAME FACILITY ADDRESS SITE PHONE#WITH AREA CODE CITY LL '' STATE ZIPP CODE #OF TANKS AT SIR S-rc>c x L')1q CA `lJ—Dt-011-- 3 APPLICANT BILLING NAME APPLICANT CONTACT NAME APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# Closure Installation Repair Retrofit ACTIVE FACILITY 2004 2005 2006 2007 2008 2009 $500 FEE INCLUDES FACILITY FEE+1 TANK(2004-2007) $550 FEE INCLUDES FACILITY FEE+1 TANK(2008-2009) $ $125 PER TANK AFTER FIRST TANK $ TANK PENALTY ASSESSED $ TANK SURCHARGE=$15/TANK $ STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$49.00/FACILITY PERMANENT CLOSURE Removal or Permitted Closure in Place $ TANK ID#(a): CLOSURE FEE=$345/TANK #TANKS X$345= TEMPORARYCLOSURE Plan Review and Inspections) $ TANK ID#(a): TEMPORARY CLOSURE FEE=$345/FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Inspections) $ TANK ID#(s): PLAN CHECK FEE=$920/FACILITY REPAIR PLAN CHECK TANK ID#(s): $ TANK RETROFIT REPAIR FEE FACILITY (use for monitoring equipment,w1d starts,EVR upgrades, 6 (� s ill buckets,sum s,misc. $ PIPING REPAIR FEE _$345/FACILITY use for piping,under-dispenser containment,ed. MISCELLANEOUS $ TRANSFER FEE _ $2 CONSULTATION FEE = $115/HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $115/MOUR $ SAMPLING INSPECTION FEE _ $115/HOUR ALL FEES ARE BASED ON THE 5115 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. OFFICE USE ONLY r RVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED R EH 23032(REVISED 07101109)