COMPLIANCE INFO_2006-2012 - Laserfiche WebLink

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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street,Stockton,CA 95202-3029 Telephone.(209)468-3420 Fax:(209)468-3433 Web:www.silrov.or /g ehd FACILITY NAME FACILITY CONTACT NAME FACILITY ADDRESS SITE PHONE#WITH AREA CODE CITY STATE ZIP CODE #OF TANKS AT SITE CA2. APPLICANT B NG NAME APPLICANT CONTACT NAME APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE oe CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# Na Closure Installation Re it Retrofit ACTIVE FACILITY IY 2003 2004 2005 2006 2007 2008 $500 FEE INCLUDES FACILITY FEE+1 TANK(2002-2007) $550 FEE INCLUDES FACILITY FEE+1 TANK(2008) $125 PER TANK AFTER FIRST TANK TANK PENALTY ASSESSED TANK SURCHARGE=$15/TANK STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$24.00/FACILITY PERMANENT CLOSURE Removal or Permitted Closure in Place TANK ID#is): CLOSURE FEE_$315/TANK #TANKS X$315= TEMPORARY CLOSURE an Rewew andlns cions TANK ID#(s): TEMPORARY CLOSURE FEE_$315/FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Inspections) TANK ID#(s): PLAN CHECK FEE_$840/FACILITY REPAIR PLAN CHECK -TANKID#(s): _ TANK RETROFIT REPAIR FEE =$315/FACILITY (use for monitoring equipment,cold starts,EVR upgrades, spill buckets,sumps,misc. PIPING REPAIR FEE _$315/FACILITY (use for piping,under-dispenser containment,act. MISCELLANEOUS TRANSFER FEE _ $20 CONSULTATION FEE _ $105/HOUR UNAUTHORIZED RELEASE EVALUATION FEE = $105/HOUR SAMPLING INSPECTION FEE = $105/HOUR ALL FEES ARE:BASED ON THE$105 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. OFFICE USE ONLY SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED SIS _ EH 23 032(REVISED 7/18/08)