Laserfiche WebLink
SAN JOAQUIN LOCAL HEALTH DISTRICT <br />Uh -.DnIINn CTnpArr TAwY DOnr.DAw _ rrr unnvcurr• <br />F FACILITY/SITE NAME FACILITY CO(ITACT NAME <br />h <br />C <br />m�-Oi_1_Com�anx Western Meter Service, Inc. <br />- <br />ADDRESS <br />LSTPE134 <br />I 75 Jacktone Rd. <br />— <br />-- - - ---------- <br />SITE PHONE I WITH AREA COBE <br />Y CITY <br />Lodi, - <br />- ---- -- <br />STATE 21P CODE I of Tanks <br />CA 95240 -(at Site Three (3) <br />--- <br />F APPLICANT/BILLING HAMS <br />_..-- -L----- <br />APPLICANT CONTACT NAME <br />P Western Meter Service, Inc. <br />L------.----.—_____._._.._..__..___----_---..._..._ <br />Wesley DuBose <br />I MAILING ADDRESS <br />APPLICANT PHONE I WITH AREA CODE <br />A egee_�irve ._Suit.e.--E•-----_._.--.-----......_....._�209.�_948 <br />_6124-- <br />k CITY <br />T <br />S1ATE TIP CODE TYPE of APPLICATION <br />CA 95205 CLOeuRE, INSTALLATION$ ETD. Removal <br />CILITY FEE = f100,Oq each SITE ADDRESS per YEAR <br />---- -... -- ._. _... ......._........_........ <br />- ------ - <br />TOTAL <br />1386 1381 <br />T <br />FEARk <br />TFEE = 150.00 each TANK <br />- - - -------- <br />- --- — — <br />l 1388 1383 <br />F I Tanks x s50.00 1986 1987 <br />A (multiD y 1 by fee for--- <br />C each year applicable) <br />1398 1389 - <br />-- L_�9 !Q _ <br />5 ll Il <br />iso <br />L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH 4 SAFETY CODE Sec 25281 for applicability) <br />T 1 Tanks_ z $56.00 1996 1901 1388 1389 �9Q0 <br />Y (enter amount and yeari --_---------..--.--_---------_------.---•--- <br />C PERMANENT CLOSURE (Removal or Closure -in-place) <br />L---- - - --- - --- - <br />0 CLOSURE FEE _ $90.00 each TANK <br />S ------ --- <br />- ---- - - - --- <br />t Tanks ___• x (30.00 <br />I <br />UR <br />a270.00 <br />TEMPORARY CLOSURE (Only allowed one tine for up to two years) <br />TEMPORARY CLOSURE FEE = $80.r00 each TANK <br />I Tanks x $80.00 <br />------------------------- <br />--------------- <br />- - <br />P PLAN CHECK (Installation or Repair) <br />L----- - <br />--- -- -.... - - - -- — <br />A <br />_ - - - -- ---- <br />N PLAN CHECK. FEE = $30,00 each SUBMISSION/RESUBMISSION <br />1 <br />-- - - <br />REPAIR <br />-- - — - - — <br />---- - ---...----- _-------....... <br />R TANK REPAIR FEE = $110.00 each TAtIK <br />E-------- - -.... - <br />-._...................- -- ------ — -- <br />II Tanks______ x fIl0.U0 f <br />_....._.,_..__..._..- --..._._...- - — <br />A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br />R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION - SAMPLING INSPECTION <br />(when applicable) (when applicable) (when applicable) <br />— <br />FEE = 130.00/hr FEE = 135.00/hrI <br />FEE _ $35.00/hrf <br />f <br />TOTAL DUE <br />f <br />YrriLe VaC VAU • E VO IVV <br />WEEPS 1 COMP I ILOC CODEI DIST CODEI AMOUNT DUE I AMOUNT P,CVD I CHECK I/CASH I RCVD BY I DATE RECEIVED I PERMIT 1 <br />