Laserfiche WebLink
OM ENTAL HEALTH DEPARTMENT , <br /> 600 East Main Street Stockton,CA 95202-3029 <br /> Mephone:.(209)468-3420.F=(209)468-3433 Web:www gigoiwWebd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> y! I <br /> $ F <br /> FACILITY ADDRESS SITE PHONE.#WITH AREA CODE <br /> CITY <br /> ZIP CODE OF TANKS AT SITE <br /> Lo CA <br /> APPLICANT 131WNG NAME APPLICANT CONTACT NAME <br /> �.1 <br /> :APPLICANT MAILING ADDRES <br /> ' •APPLICANT PHONE#WITH AREA CODE. . <br /> _CITY STATE ZIP CODE <br /> CIRCLE WORK TO 13E DONE Coffm CTOR ICC# <br /> Closure Inst�llatio_n R Retrofit <br /> AC, FACILITY <br /> $Soo FEE INCLUOE&FACILITY FEE+.ITANK(2006-20oi) 2006 2o07- 2008 2009" 2010 2011 <br /> $M FEE INCLUDES FACILITY FEE+.1 TANK(2008-2011) . <br /> $125 PER.TANKAFTER FIRSTTANK <br /> TANKP-ENALTKASSESSED ._. __. __ --- - -. - - -- <br /> TANK SURCHARGE=$15/TANK - <br /> STATE SURCHARGE FOR FACIU77ES NOTALREADY ON INVENTORY lIf A COPA PRn-,RAM X49.00/FACILffY $ + <br /> F'>`RMANENT CLOSURE <br /> em6m-or Permitter Closure in Place <br /> `TANK-ID, <br /> .#(s)+: .CLOSURE FEE.=$375/TANK #TANKS X$375= <br /> TEAAPORARY CLQ$URE _ <br /> --Man Review and i actions <br /> ,TANK (): TEMPORARY CLOSURE FEE_$375/FA 11Lfy <br /> INSTi4LLATIQN PLAN CHECK <br /> Plan Check anrtCons6iuction'I oris <br /> _ .: . PLAN OHECfC. EE_$1;OQ0 f P.ACIL[tl ... . <br /> REPAIR PLAN CHECK <br /> .. - nv_ ...,.. <br /> _ - - - - <br /> _ - - _ <br /> -- - :. <br /> fia�en�ton�9�9atpment=�old:-s ----_.�. <br /> 111iakets 7ntac _ - <br /> __-- <br /> �seTor ung -aontainm.-f--4 <br /> - 1 iN1e@W—, <br /> .._..-..ate._....._.... <br /> 7RANSFWFEE $25` <br /> "CON9UL�aT70PtPEE _-- -- <br /> $:125�''HOU <br /> R <br /> >.. .-._ ___....... �F7.E �T-LA UATIONFF.E - $125/-HOUR. _ _ " -•.-.. <br /> SA�PUNC'INSPECTION FEET - <br /> BAS ON THE$12b HO RLY RATE.TIAAE THAT EXCEEDS FEES PAID - - <br /> WILL BEBILLED rO APPLICANT' <br /> ®UE _ <br /> _SF i/I6EttEQUES1 - :"FACILITY)ll <br /> AMGUN T RECEiVEp -- CHECif v - SEGgyED BY DATE RECEIVED 3 <br /> S32(REVISt:D 08L1M <br /> i <br /> r <br />