Laserfiche WebLink
FROM OIL EQUIPMENT PHONE NO. : 209 7545726 Nov. 16 2001 08:21PIl P6 <br /> ,%%/ .J <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> FACILITY NAME FACILITY CONTACT NAME <br /> 3 Palms Grocery Rud Mendonca <br /> FACILITY ADDRESS SITE PHONE Lr WITH AREA C <br /> 6732 E. Waterloo Rd. 209 931 -6048 <br /> CITY S ATE ZIP CODE #OF TANKS AT SR <br /> Stockton CA 95215 2 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Oil Equipment Service <br /> APPLICANT MAILING ADDRESS APPLICANT PHON WITH AREA CODE <br /> P.O. Box 950 209 754-1808 <br /> CITY STATE ZIP C CIRCLE WORK TO BE DONE: <br /> San Andreas CA 95249 Closure Installation Repair Ravorit <br /> ACTIVE FACILITY <br /> $500 FEE INCLUDES FACILITY FEE+ 1 TAN1995- 1999 2000 <br /> K ($170)X(#tanks)X(#of years applicable) <br /> $125 PER TANK AFTER FIRST TANK <br /> TANK PENALTY ASSESSED $ <br /> TANK SURCHARGE=$8/TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY M A CUPA PROGRAM=$101 FACILITY $ <br /> PERMANENT CLOSURE <br /> Rem I or P melted Closure In Place <br /> TANKID# s CLOSURE FEE_$261/TANK #TANKS X S261 . $ <br /> TEMPORARY CLOSUR <br /> Plan Review and I acrons <br /> TANK 10#(s): TEMPORARY CLOSURE FEE_$261 /FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> plan Check and Construction Inspections) <br /> I.TANK ID#(s): PLAN CHECK FEE=$698!FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID# s : <br /> TANK LINING REPAIR FEE =$261/TANK _ #TANKS X$261 $ <br /> TANK RETROFIT REPAIR FEE =$261/FACILITY <br /> PIP NG REPAIR FEE = 261 /FACILITY <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $20 $ <br /> CONSULTATION FEE _ $87/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = S 87/HOUR $ <br /> SAMPLING INSPECTION FEE _ $87/HOUR $ <br /> ALL FEES ARE BASED ON THE$al HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REOUESTi I FACILITY to AMOUNT RECEIVED I CHECKiRECEIVEDaY DATER IVSD <br /> SIR <br /> EH 23 032(REVISED 9.214)01 <br />