Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468.3433 Web:www sjeov or¢/ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> 24219Morada <br /> Dawn Dirckson <br /> ADDRESS SITE PHONE N WITH AREA CODE <br /> Lane, Stockton CA 95212 209-9 6-9300 <br /> STATE ZIP CODE #OF TANKS AT SITE <br /> CA 95212 <br /> 3 <br /> APPLICANT BILLING NAME APPLICANTCONTACT NAME <br /> Able Maintenance Inc Mart Weithman <br /> APPLICANT MAILING ADDRESS APPLICA;PHONE N WITH AREA CODE680 Quinn Ave. 408- 8 <br /> CITY STATE ZIP CODE CIRCTO BE DONE CONTRACTOR ICC# <br /> San Jose CA 9511211 E7 <br /> C; <br /> 5250610 <br /> ACTIVE FACILITY <br /> $500 FEE INCLUDES FACILITY FEE i 1 TANK(2003-2008) 2004 2005 2006 M20O8$550 FEE INCLUDES FACILITY FEE+ 1 TANK(2009) <br /> $125 PERTANK AFTER FIRST TANK $ <br /> TANK PENALTY ASSESSED $ <br /> TANK SURCHARGE=$15l TANKSTATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGR $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID#(a): CLOSURE FEE=$315/TANK #TANKS X$315= $ <br /> TEMPORARY CLOSURE <br /> Pian Review and Inspections) <br /> TANK ID N(s): TEMPORARY CLOSURE FEE=$315/FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan Check and ConsVudion Ins actions <br /> TANK ID#(s): PLAN CHECK FEE_$840/FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <br /> TANK RETROFIT REPAIR FEE =$315/FACILITY (use for monitoring equipment,void starts.EVR upgrades, $ <br /> s III buckets,sum s misc.1 <br /> 456 <br /> PIPING REPAIR FEE =$315/FACILITY use for piping,under-dispenser containment,act.) $ <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $20 $ <br /> CONSULTATION FEE = S 1061 HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $ 1051 HOUR $ <br /> SAMPLING INSPECTION FEE = $ 105/HOUR $ <br /> ALL FEES ARE BASED ON THE$105 HOURLY RATE. TIME THAT E%LEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REOUESTp FACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BV GATE RECEIVED <br /> SR <br /> EH 23 032(REVISED 02J231 09) <br />