Laserfiche WebLink
SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTHDEPARTMENT RECE040 <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telepli oma: (209) 468-3420 Fax: (209) 468-3433 Web: www_sjgov_org/ehd <br />EUS a tbnxi?-� c <br />APPLICANT MAILING ADDRES. _ <br />25�6 W WAWIAR-) C� <br />CITY _ <br />STAC%�fl — <br />ACTIVE FACILITY — <br />$500 FEE INCLUDES FACILITY I :E: + 1 TANK (2006.2007) <br />$550 FEE INCLUDES FACILITY I R7 + 1 TANK (2008-2011) <br />$125 PER TANK AFTER FIRST T .NIC <br />TANK PENALTY ASSESSED _ <br />TANK SURCHARGE = $15 / TArl <br />STATE SURCHARGE FOR FACII T1I=S NOT ALREADY <br />la <br />2007 <br />201 <br />ON INVENTORY IN A CUPA PROGRAM X49.00/ FACILITY I - I <br />INSTALLATION PLAN CHECK <br />Plan Check and Construction Ins) is Ions <br />TANK ID # (s) : — PLAN CHECK FEE _ $1,000 / FACILITY $ <br />REPAIR PLAN CHECK <br />TANK ID # (s) : ' <br />TANK RETROFIT REPAIR FEE = 6Z'75 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, <br />s ill buckets sumps, misc.) <br />PIPING REPAIR FEE = $375 / F7 ',ILITY use for piping, under -dispenser containment, ect. <br />MISCELLANEOUS <br />TRANSFER FEE _ $ 25 <br />CONSULTATION FEE <br />UNAUTHORIZED RELEASE EVAi JE <br />SAMPLING INSPECTION FEE_ <br />ALL FEES -ARE BASED ON THE$12a IC <br />W <br />APPLICANT CONTACT NAME <br />$ <br />OUR <br />APPLICANT PHONE # WITH AREA CODE <br />,TION FEE _ $125 / HOUR <br />$ <br />STATEZIP <br />CODE <br />CIRCLE WORK TO BE DONE <br />CONTRACTOR ICC # <br />Closure, Installation Repair Retrofit <br />ACTIVE FACILITY — <br />$500 FEE INCLUDES FACILITY I :E: + 1 TANK (2006.2007) <br />$550 FEE INCLUDES FACILITY I R7 + 1 TANK (2008-2011) <br />$125 PER TANK AFTER FIRST T .NIC <br />TANK PENALTY ASSESSED _ <br />TANK SURCHARGE = $15 / TArl <br />STATE SURCHARGE FOR FACII T1I=S NOT ALREADY <br />la <br />2007 <br />201 <br />ON INVENTORY IN A CUPA PROGRAM X49.00/ FACILITY I - I <br />INSTALLATION PLAN CHECK <br />Plan Check and Construction Ins) is Ions <br />TANK ID # (s) : — PLAN CHECK FEE _ $1,000 / FACILITY $ <br />REPAIR PLAN CHECK <br />TANK ID # (s) : ' <br />TANK RETROFIT REPAIR FEE = 6Z'75 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, <br />s ill buckets sumps, misc.) <br />PIPING REPAIR FEE = $375 / F7 ',ILITY use for piping, under -dispenser containment, ect. <br />MISCELLANEOUS <br />TRANSFER FEE _ $ 25 <br />CONSULTATION FEE <br />UNAUTHORIZED RELEASE EVAi JE <br />SAMPLING INSPECTION FEE_ <br />ALL FEES -ARE BASED ON THE$12a IC <br />W <br />$ <br />OUR <br />$ . <br />,TION FEE _ $125 / HOUR <br />$ <br />$1251 HOUR <br />URLY RATE TIME THAT EXCEEDS FEES PAID <br />$ <br />ILL BE BILLED TO APPLICANT, <br />TOTAL AMOUNT DUE _ $ <br />OFFICE USE ONLY <br />SERVICE REQUEST# I FACILfi <br />EH 23032 (REVISED 0811111 by KF) <br />S'd ZbE9T9f,602T SJ040equ00 AI agT13 <br />LTH <br />d6T �ZT �T co IAC <br />