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BO/21/2006 15.54 4540138 ENVIRONMENTAL HEALTH PAGE 01 <br /> SAN JOA.QUIN COUNTY <br /> 1�tNVRONMESCAL HEALTu DFPA12TMENT* <br /> 304 East Weber Avenue.311 Floor,Stockton,CA 45202-2708 <br /> Telephone:(209)468-3420 Fax(5`a floor):(249)468-3433 Web:ww�ww s>i ov.nrglchd <br /> FACILITY E FACiLffY CONTACT NAE <br /> FACILITY ADDRESS SITE PHONE 0 WrrH AREA CODE <br /> Lj <br /> CITY An ZIP COVE <br /> OFT AT 517E <br /> CA <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE 2 WITH AREA CODE <br /> CITY <br /> STATE ZIP LODE CIRCLE WORK TO SE DONE CONTRACTOR ICC# <br /> Ck"ura inst0113tkx4 rtepalr Retmnt <br /> ACTIVE FACILITY <br /> 2001 2D02 2003 20D4 2005 20Dfi <br /> S500 FEE INCLUDES FACILITY FEE+1 TANK <br /> $125 PER TANK AFTER FIRST TANK <br /> TANK PENALTY ASSESSED $ <br /> TANK SURCHARGE=S15 f TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CtJPA PROGRAM-$24.0 !FACILITY <br /> PERMANENT CLOSURE <br /> {Removal or Permitted Closure in Place <br /> TANK ID 0 SI* CLOSURE FEE=52851 TANK *TANKS X$295 <br /> IE6IFORARY CLOSURE <br /> Pian Revlaw and to ctions <br /> -TANK-109(s): TEMPORARY CLOSL3RE FEE$$285 /FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Chack and ConstRrclfon Inspections) $ <br /> TANK ID#(s); PLAN CHECK FEE-$7601 FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID# S <br /> TANK RETROFIT REPAIR FEE �$2651 FACILITY use for manitorin 1 s ill budrats,lank sum <br /> misc, <br /> PIPING REPAIR FEE 5285 l FACILITY <br /> use for under cr Containment,cct <br /> MISCgLLANEOUS T <br /> TRANSFER FEE ' $20 $ <br /> CONSULTATION FEE = S 951 HOUR $ <br /> LINAU7NORIZED RELEASE EVALUATION FEE = $951 HOUR $ <br /> SAMPLING INSPECTION FEE = S 951 HOUR <br /> A FEES ARE BASED ON THE Sts ry t muY RATE- T1ME THAT p(GEE DS FEES PAID WILL.BE gtLLED TO APPLICANT• <br /> OFFICE USE ONLYi DATE RECEIVED <br /> S6 VICE EGttEST• FACILITY ID AMDt1Iti r IeECE11rED CHEEK Ii <br /> SIR <br /> EH 23 Q32#ttEviSED o7t2ero6l <br />