COMPLIANCE INFO_2003-2009 - Laserfiche WebLink

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0SAN JOAQUA COUNTY J0 ENVIRONMENTAL HEALTH DEPAR 304 East Weber Avenue, 31a Floor, Stockton, CA 95202-2708 Telephone: (209) 468-3420 Fax (P floor): (209) 468-3433 Web: www.sigov.org/ehd FACILITY NAME FACILITY CONTACT NAME APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE 2001 FACILITY ADDRESS SITE PHONE # WITH AREA CODE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # CITY I STATE ZIP CODE # OF TANKS AT SITE CA TANK ID # (s) : TEMPORARY CLOSURE FEE = $285 / FACILITY APPLICANT BILLING NAME APPLICANT CONTACT NAME Removal or Permitted Closure in Place APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE 2001 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # 2006 Plan Review and Inspections) Closure Installation Repair Retrofit ACTIVE FACILITY Removal or Permitted Closure in Place TANK ID # s 2001 2002 2003 2004 2005 2006 Plan Review and Inspections) $500 FEE INCLUDES FACILITY FEE + 1 TANK TANK ID # (s) : TEMPORARY CLOSURE FEE = $285 / FACILITY $ $125 PER TANK AFTER FIRST TANK TANK PENALTY ASSESSED $ TANK SURCHARGE = $15 / TANK -i- $ NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$24.00/ FACILITY STATE SURCHARGE FOR FACILITIES PERMANENT CLOSURE Removal or Permitted Closure in Place TANK ID # s TANK RETROFIT REPAIR FEE = $285 / FACILITY use for monitoring equipment, spill buckets, tank sumps, misc. TANK ID # (s): CLOSURE FEE= $285 /TANK # TANKS X $285 = TEMPORARY CLOSURE Plan Review and Inspections) SAMPLING INSPECTION FEE _ $ 95/ HOUR ��pe runT execans FFFs adlD WILL BE BILLED TO APPLICANT. TANK ID # (s) : TEMPORARY CLOSURE FEE = $285 / FACILITY Is TANK ID # (s) : I PLAN CHECK FEE = $760 / FACILITY $ REPAIR PLAN CHECK TANK ID # s TANK RETROFIT REPAIR FEE = $285 / FACILITY use for monitoring equipment, spill buckets, tank sumps, misc. $ CONSULTATION FEE = $ 95/ HOUR $ PIPING REPAIR FEE = $285 / FACILITY use for piping, under -dispenser containment, ect. $ MISCELLANEOUS TRANSFER FEE _ $ 20 $ CONSULTATION FEE = $ 95/ HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 95 / HOUR $ SAMPLING INSPECTION FEE _ $ 95/ HOUR ��pe runT execans FFFs adlD WILL BE BILLED TO APPLICANT. ALL FEES ARE BASED ON THE $96 HOURLY KAI G. OFFICE U5E UNLY SERVICE REQUEST # FACILITY ID I AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED SR EH 23 032 (REVISED 07/28/06)