Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT D <br /> 1868 E.Hazelton Ave., Stockton,CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.s'cehd.co A'y I r! 2011 <br /> FACILITY NAME FACILITY CONTACT NAME <br /> L*4'V'1 ONMEN a HLFFF ' <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> CA <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> (As of 8/1/16) $583 FACILITY FEE+$139 PER TANK 2011 2012 2013 2014 2015 2016 <br /> Facility Fee NO LONGER INCLUDES FIRST TANK <br /> (2011-Aug 1,2016)$550 FEE INCLUDES FACILITY FEE+1 TANK $ <br /> $130 PER TANK AFTER FI TANK 7 <br /> TANK PENALTY ASSESSED r 7E j�+ $ -4 I <br /> TANK SURCHARGE=$15/TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$35.00/FACILITY $ <br /> PERMANENT CLOSURE lD 9D <br /> Removal or Permitted Closure in Place <br /> TANK ID#(s): CLOSURE FEE=$417/TANK #TANKS X$417= $ <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID#(s): TEMPORARY CLOSURE FEE=$417/FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> TANK ID#(s): PLAN CHECK FEE=$1112/FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <br /> TANK RETROFIT REPAIR FEE =$417/FACILITY (use for monitoring equipment,cold starts,EVR upgrades, <br /> spill buckets,sumps,misc. <br /> PIPING REPAIR FEE_$417/FACILITY use for piping,under-dispenser containment,ect. <br /> MISCELLANEOUS O�AT <br /> TRANSFER FEE _ $25 $kA V <br /> CONSULTATION FEE = $139/HOUR S 201? <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $139/HOUR lyk. V/RO(j/NN C0UN7y <br /> EP0AL <br /> SAMPLING INSPECTION FEE _ $139/HOUR $ TwicNT <br /> FEES ARE BASED ON THE$139 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> TOTAL AMOUNT DUE <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED <br /> EH 23 032(REVISED 07-15-2016) 1A Q30 <br /> L ca.) <br />