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0 SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sigov.org/ehd <br />RECE V <br />MAY 2 2008 <br />FACILITY NAME <br />FACILITY CONTACT NAME J <br />A <br />LrU i Iv\�WA1 L.. GS l� i i��l <br />iki.� ' `_ i Com! { "EALTH p 41 E <br />FACILITY ADDRESS <br />SITE PHONE # WITH AREA CODE <br />9-75 Scc—n4'rp,iRKAUtiiT K.; E <br />(,20) 334 - 3/-i 1 <br />CITY <br />STATE <br />ZIPCODE# <br />OF TANKS AT SITE <br />Loo i <br />CA <br />IP <br />vl J <br />$ <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />1-1 I...E-.`I W I US UTA <br />APPLICANT PHONE # WITH AREA CODE <br />APPLICANT MAILING ADDRESS <br />(.,150 0Kf hj Rtwe A Rc)P D <br />530 5U-7 - iC'Q'9? <br />CITY STATE ZIP CODE <br />CIRCLE WORK TO BE DONE <br />CONTRACTOR ICC # <br />5—y— DovAz�c <br />Closure nstallation Repair Retrofit <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 98 / HOUR <br />ACTIVE FACILITY <br />TANK ID # s <br />CLOSURE FEE = $294 / TANK <br />2003 <br />2004 <br />2005 <br />2006 <br />2007 <br />2008 <br />1 <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK (2002-2007) <br />PIPING REPAIR FEE = $294 / FACILITY use for piping, under -dispenser containment, ect. <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 98 / HOUR <br />$ <br />SAMPLING INSPECTION FEE = $ 98/ HOUR <br />$550 FEE INCLUDES FACILITY FEE + 1 TANK (2008) <br />$ <br />$125 PER TANK AFTER FIRST TANK <br />$ <br />TANK PENALTY ASSESSED <br />TANK SURCHARGE = $15 / TANK <br />$ Cj <br />$ <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 <br /># TANKS X $294 = <br />TEMPORARY CLOSURE <br />Plan Review and Ins ections <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = $294 / FACILITY <br />INSTALLATION PLAN CHECK <br />Plan Check and Construction Inspections) <br />TANK ID # (s) : <br />I PLAN CHECK FEE = $784 / FACILITY <br />REPAIR PLAN CHECK <br />TANK ID # (s) : <br />$ <br />$ <br />TANK RETROFIT REPAIR FEE = $294 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, <br />spill buckets, sumps, misc.) <br />CONSULTATION FEE = $ 98/ HOUR <br />1 <br />$ <br />PIPING REPAIR FEE = $294 / FACILITY use for piping, under -dispenser containment, ect. <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 98 / HOUR <br />MISCELLANEOUS <br />$ <br />TRANSFER FEE _ $ 20 <br />$ <br />CONSULTATION FEE = $ 98/ HOUR <br />$ <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 98 / HOUR <br />$ <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 />M��� 0 wilmpffrlam <br />EH 23 032 <br />