Laserfiche WebLink
Nov 30 10 05:24p Reliable Petrol&A ? -845-8953 p.6 <br /> SAN JOAQUII\COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMPNT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web.w'ww.sjgov.Drglehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> L P-V h(z. '1P 5 H ALL N i c iL A>^ o. A n <br /> FACILITY ADD SS SITE PHONE#WITH AREA CODE <br /> ) GS-00 S. 6&rl 60h ( -)O q) 3859 <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> La ino(D CA 9533( <br /> APPLICANT BILI !N6 NAME APPLICANT CONTACT NAME <br /> leL4 lin Strvi c.-5 =n c ✓P_r— arm A r <br /> APPLICANT MAI JING ADDRESS APPLICANT PHONE#1MTH AREA CODE <br /> I I I.3 D 12d, F = 55, 6 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> Qa cL (' �1{- Jc$?j(� Closure Installation Repair Retrofit 5252 Sof <br /> ACTIVE FACIL <br /> $500 FEE INCLUC ES FACILITY FEE+1 TANK(2005-21307) 2005 2006 -1"8 2009 2010 <br /> $550 FEE INCLUE ES FACILITY FEE+1 TANK <br /> $126 PER TANK AFTER FIRST TANK $ <br /> TANK PENALTY ASSESSED EE $ <br /> TANK SURCHAR E=$151 TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$49.t1{N FACILITY $ <br /> PERMANENT CL URE <br /> (Removal or Permi ed Closure in Place <br /> TANK ID# s CLOSURE FEE_$366 t TANK #TANKS X$366= $ <br /> TEMPORARY CLOSURE <br /> Plan Review and t ctions) <br /> TANK ID#(s): TEMPORARY CLOSURE FEE_$366/FACILITY $ <br /> INSTALLATION PiAN CHECK <br /> Plan Check and CA instruction Inspections) <br /> TANK ID#(s): PLAN CHECK FEE=$976/FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANKID#(S): <br /> TANK RETROFIT REPAIR FEE =$366 I FACILITY (use for monitorin $ <br /> g equipmenk,cold starts,EVR upgrades, <br /> —M twckets,sum s,misc. 2 <br /> PIPING REPAIR FEE _$3661 FACILITY (use for Piping,under-dispenser containment,ed.) <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $25 $ <br /> CONSULTATION FEE _ $1221 HOUR $ <br /> UNAUTHORIZEDLEASE EVALUATION FEE _ $122!HOUR $ <br /> SAMPLING INSPE TION FEE _ $1221 HOUR $ <br /> ALL FEES ARE BASE 6 ON THE$122 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL SE BILLED TO APPLICANT, <br /> OFFICE USE ON Y <br /> SERVICE REQUEST I LITY ID I AMOUNT REGENEDCHECKts RECEIVED BY DATE RECEIVED <br /> SR <br /> EH 23 032(REVISED 121110) <br />