Laserfiche WebLink
SAN JOAQUIN Cot NA",' <br />ENVIRONMENTAL HFAl;fll DI:PARTMI NI' <br />600 East Main Street, Stockton, CA 95202-3029 <br />7e(ej)hone: (209) 468-3420 Fax: (209) 468-3433 Keh: www.sjsov.org/ehd <br />FACILITY NAME <br />FACILITY CONTACT NAME <br />Arco <br />Lawrence <br />FACILITY ADDRESS <br />SITE PHONE # WITH AREA CODE <br />130 S Wilson Way <br />(209) 466-9516 <br />CITY STATE <br />ZIP CODE # OF TANKS AT SITE <br />CjI OC -O CA <br />I S 2-4, <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />HMC - Henderson Maint Co <br />Carl W Henderson <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />PO Box 31325 - Stockton, CA 95213 <br />(209) 467-7573 <br />CITY <br />STATE <br />ZIP CODE CIRCLE WORK TO BE DONE <br />CONTRACTOR ICC # <br />PIPING REPAIR FEE = $294 / FACILITY (use for piping, under -dispenser containment, ect.) <br />Closure Installation Repair Retrofit <br />ACTIVE FACILITY <br />TANK ID # s <br />CLOSURE FEE _ $294 /TANK # TANKS X $294 = <br />2003 <br />2004 <br />2005 <br />2006 <br />2007 <br />2008 <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK (2002-2007) <br />$ 315.00 <br />PIPING REPAIR FEE = $294 / FACILITY (use for piping, under -dispenser containment, ect.) <br />SAMPLING INSPECTION FEE _ $ 98/ HOUR <br />$550 FEE INCLUDES FACILITY FEE + 1 TANK (2008) <br />$125 PER TANK AFTER FIRST TANK <br />$ <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 />PERMANENT CLOSURE <br />(Removal or Permitted Closure in Place) <br />TANK ID # s <br />CLOSURE FEE _ $294 /TANK # TANKS X $294 = <br />TEMPORARY CLOSURE <br />Plan Review and Inspections) <br />TANK ID # (s) <br />TEMPORARY CLOSURE FEE = $294 / FACILITY <br />INSTALLATION PLAN CHECK <br />Plan Check and Construction Inspections) <br />TANK ID # (s) : PLAN CHECK FEE = $784 / FACILITY <br />REPAIR PLAN CHECK <br />FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br />TANK ID # (s) <br />TRANSFER FEE _ $ 20 <br />TANK RETROFIT REPAIR FEE = $294 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, <br />spill buckets, sumps, mist. <br />$ 315.00 <br />PIPING REPAIR FEE = $294 / FACILITY (use for piping, under -dispenser containment, ect.) <br />MISCELLANEOUS <br />FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br />SR <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 $98 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br />OFFICE USE ONLY <br />SERVICE REQUEST # <br />FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br />SR <br />EH 23 032 (REVISED 12/31/07) <br />