COMPLIANCE INFO_2009-2012 - Laserfiche WebLink

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. SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street,Stockton,CA 95202-3029 Telephone:(209)468-3420 Fru:(209)468-3433 Web:www.sigov.org/ehd F ILITY NAME FACILITY CONTACT NAME FAC ILITYADDRESS SITE PHONE#WITH AREA CODE CITY TATE ZIP CODE I #OF TANKS AT SITE tet` CA APR41r,ANT,BILLING NAME APPLICANT CONTACT NAME APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA ODE CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# Closure Installation Repair Retrofit ACTIVE FACILITY 2002 2003 2004 2005 1 2006 2007 $500 FEE INCLUDES FACILITY FEE+1 TANK(2002-2007) $550 FEE INCLUDES FACILITY FEE+1 TANK(2008&New Installs as of$11107) $ $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=$24.001 FACILITY $ PERMANENT CLOSURE Removal or Permitted Closure in Place TANK ID#(s): CLOSURE FEE=$294 1 TANK #TANKS X$294= $ TEMPORARY CLOSURE Plan Review and Inspections) TANK ID#(s): TEMPORARY CLOSURE FEE_$294 1 FACILITY $ INSTALLATION PLAN CHECK (Plan Check and Construction Inspections) TANK ID#(s): PLAN CHECK FEE_$7841 FACILITY $ REPAIR PLAN CHECK TANK ID#(s): ' TANK RETROFIT REPAIR FEE _ /FACILITY use for monitoring equipment,spill buckets,tank sumps,misc.) PIPING REPAIR FEE =42 FACILITY (use for piping,under-dispenser containment,ect.) [CONSULTATION ISCELLANEOUS RANSFER FEE _ $20 $ FEE _ $981 HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $98!HOUR $ SAMPLING INSPECTION FEE = $981 HOUR $ ALL FEES ARE BASED ON THE$98 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT, OFFICE USE ONLY =SR UEST# FACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED EH 23 032 rREVISM Mmn7l