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FROM :B.Z.SERVICESTRTION MAIN' aNCE FRX NO. :916 371 2540 qug. 11 2006 01:22PM P4 <br /> SAN JOAQUIN CO(INCY <br /> ENVIRONMENTAL HEALm DY,PARTMENT <br /> 304 East Weber Avenue,Yd Flair,Stockton,CA 95202-2708 <br /> TeleOkane.(2(9)469-3420 Fax(5'Jkw)t(209)468-3433 Web:www--§jw.org/szhd- <br /> CONTACT�AC'IL`IT.YaCONTACT NAME <br /> FACILITY ADDRESS. &TE PHONE$WITH AREA CODE <br /> CITY STATE 2IP CODE 0 OF TANKS AT WE <br /> —00—mmT BILLING NAME APPLICANT CONTACT NAME <br /> AD n <br /> �3 �a8, % m ex, . . f <br /> ppIJCANT MAILING ADD ESS A 41CANT PHONE S WITH AREA CODE <br /> qai� F <br /> Tf <br /> CITY �iT.ATE 21P COPE CIRCLE WORK*BE DONE CONTRACTOR II�C�C7Y� <br /> I-t'c 5 I Closum n� Retrofit _,SaS� �Y'�AI <br /> ACTIVE FACILITY <br /> 2000 2001 2002 2003 2004 2005 <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK <br /> $125 PER TANK AFTER FIRST TANK - " $ <br /> TANK PENALTY ASSESSED,_ _... _ <br /> TANK SURCHARGE-515/TANK .. -._ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=524.001 FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Plain) .. . . <br /> TANK ID t e CLOSURE FEE= 9/TANK Y TANKS X$279 <br /> TEMPORARYCLOSURE <br /> plan RavISW and Inn ons <br /> TANK ID Y(a): TEMPORARY CLOSURE FEE=5278/FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and CcestnxtIon.Inspections) <br /> TANK ID N(S). T-- PLAN CHECK FEE F$744/FACILITY $ _ <br /> REPAIR PLAN CHECK <br /> PIPING REPAIR FEE •$279/FACILITY FACILITY (use for monitoring Nulprnent.spill bucota,tank sumps,miac <br /> TANK RETROFIT REPAIR FEE �$27misc.) $ <br /> .. (use for _ andel-tliapenaeT containment,Oct.) $ <br /> MISCELLANEOUS <br /> TRANSFERFEE,... = $20 <br /> CONSULTAT19VFEE = 593(HOUR „.... <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $93/HOUR „ <br /> SAMPLING INSPEL''1 ION FEE _ $93/HOUR <br /> ALL FEES ARE SASW ON THE$e3 FgURLY RATE. TIME TNAY EMCEED$ WILL BIL 7D APPLICANT. <br /> OFFICE USE ONLY <br /> REQUESTY FACIUTY ID AM OUNTRECENEDKY_, I PrECEPAD BY I ,TE <br /> SR <br /> EH 23 032(REVIVED 0212211$) <br />