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Jul. 10. 2008 10. 32AM West Star Envi ron_mentaI, Inc. ,UNW No, 8964 P. 2 <br /> ` . ENVIRONMENTAI,IISALTH DP PART <br /> 600 Bast Main Street,Stockton,CA 95202 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www,si,k v_oro ehd <br /> FACILITY NAME ./fin FACILITY CONTACT NAME <br /> A Y &�` <br /> FACILITY ADDRESS S17E PHONE#WITH AREA CODE <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> Closure Insbliaflon e it etro6t ®(� <br /> ACTIVE FACILITY <br /> 2003 2004 2005 2006 24Q7 2008 <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK(2002-2007) $ <br /> $550 FEE INCLUDES FACILITY FEE+1 TANK(2008) <br /> $125 PER TANK AFTER FIRST TANK $ <br /> TANK PENALTY ASSESSED $ <br /> TANK SURCHARGE=$15/TANK <br /> T- <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$24.Q/FACILITY <br /> PE ENT CLOSURE <br /> Bern[valor Perm' Closure in Place $ <br /> TANK ID#(a): CLOSURE FEE_$294/TANK #TANKS X$294= <br /> TEM RY CLOSURE <br /> Plan Review and Inspections) $ <br /> TANK ID#(S): TEMPORARY CLOSURE FEE=$294/FACILn-Y <br /> INSTALLATION PLAN CHECK <br /> lan Chack and Consimc ion InspectionsI, $ <br /> TANK ID#(s): PLAN CHECK FEE=$784/FACILITY <br /> REPAIR PLAN CHECK <br /> TANK-1-05-4(a): - $ <br /> TANK RETROFIT REPAIR FEE =$294/FACILITY (use for monitoring equipment,cold starts,EVR upgrades, <br /> spill buckets,sumps,mise) $ <br /> use forppin ,PIPINGREPAIRFEE Under-d! ontainment,ec ) <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $20 $ <br /> CONSULTATION FEE = $98/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $98/HOUR $ <br /> SAMPLING INSPECTION FEE = $98/HOUR <br /> ALL FEES ARE BAS QN THE$ss HOURLY RATE. TUM THAT EXCEEDS FEES PAID N/ILL BE BILLED TQ APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK X.. RECEIVED BY DATE RECEIVED <br /> SR <br /> eu-)7 M�ior_viexn <br />