Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> EWIRONMENTAL HEALTH DEPARTm— r <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sjgov.orwehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> C r Q� d b4�+ vrinn <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 16,4 r)b Y I � 4358 `411 to <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> L�..-1 xro CA <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> LL}e 1 V 1 rYxc enc &XR e a, <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE*WITH AREA CODE <br /> o?S 5 I.JL aYr 09 �(QI - (033'7 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> CA 1 -1 S�S Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK(2002-2007) 2002 2003 2004 2005 2006 2007 <br /> $550 FEE INCLUDES FACILITY FEE+1 TANK(2008&New <br /> Installs as of 8/1/07) $ <br /> $125 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=$24.00/FACILITY $ <br /> F <br /> RMANENT CLOSUREemoval or Permitted Closure in PlaceNK ID# s - CLOSURE FEE=$294/TANK #TANKS X$294= $ <br /> MPORARY CLOSURE <br /> Pian Review and Inspections) <br /> TANK ID#(a): TEMPORARY CLOSURE FEE=$294/FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Ian Check and Construction Inspections) <br /> TANK ID#(a): PLAN CHECK FEE_$784/FACILITY $ <br /> EREPAIRPLAN CHECK <br /> # s : <br /> TROFIT REPAIR FEE =$294/FACILITY use for monitodn a ui ment,s ill buckets,tank sum mist. $air EPAIR FEE =$294/FACILITY use forpiping,under-dispenser containment,ect $ <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $20 $ <br /> CONSULTATION FEE _ $98/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $98/HOUR $ <br /> SAMPLING INSPECTION FEE _ $98!HOUR $ <br /> ALL FEES ARE BASED ON THE$88 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST I FACILIT'ID AMOUNT RECEIVED CHECK# RECEIVED BYDATE RECEIVED <br /> SR <br /> EH 21 032'REVISED 08/3/071 <br />