Laserfiche WebLink
• • RECEIVED <br /> SAN JOAQUIN COUNTY DEC 162015 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205.6232 <br /> Telephone:(209)468-3420 Far.,(209)468-3433 Web:www.sicehd.com ENVIRONMENTAL <br /> H DEPARTMENT <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Georges Mini Mart Rupi or Bill <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 18662 Highway 88 727-3064 <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> Lockford CA 95237 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Elite IV Contractors Kim White <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 2535 Wigwam Dr. 1 20 461-6337 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE I CONTRACTOR ICC# <br /> — Stockton Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> $550 FEE INCLUDES FACILITY FEE+1 TANK 2009 2010 2011 2012 2013 2014 <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#(a): CLOSURE FEE=$390/TANK #TANKS X 390= $ <br /> TEMPORARYCLOSURE <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, 390.00 <br /> spill buckets,sumps,mist <br /> PIPING REPAIR FEE_$3901 FACILITY use for piping,under-dispenser containment,act.) <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $25 $ <br /> CONSULTATION FEE = $130/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = It 130/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 is <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# I FACILITY ID I AMOUNT RECEIVED I CHECK# I RECEIVED BY GATE RECEIVED <br /> EH 23 032(REVISED 0"&14) <br />