COMPLIANCE INFO_1995-2011 - Laserfiche WebLink

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oo3�-) SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 (209) 468-3420 Fax (5`" floor): (209) 468-3433 Web: www.sgov.org/ehd FACILITY NAME APPLICANTCONTACT NAME FACILITY CONTACT NAME oS of Lr APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE FACILITY ADDRESS ,?Ao S—t 1 2'5-1 o SITE PHONE # WITH AREA CODE /o 0 CITY I STATE ZIP CODE # OF TANKS AT SITE �%v GrPI c S 1 1 APPLICANT BILLING NAME APPLICANTCONTACT NAME OS C7jL— N� PP—*"o?�1J N C-61— A APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE Vo 9,� +�, t ,?Ao S—t 1 2'5-1 o CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # Closure Installatio Repa Retrofit XX u/q (d/��) ACTIVE FACILITY TANK ID # (s): CLOSURE FEE = $279 / TANK 2000 2001 2002 2003 2004 2005 $500 FEE INCLUDES FACILITY FEE + 1 TANK $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR SAMPLING INSPECTION FEE _ $ 93/ HOUR $125 PER TANK AFTER FIRST TANK $ $ TANK PENALTY ASSESSED $ TANK SURCHARGE = $15 / TANK $ STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$24.00/ FACILITY PERMANENT CLOSURE Removal or Permitted Closure in Place TANK ID # (s): CLOSURE FEE = $279 / TANK # TANKS X $279 = TEMPORARY CLOSURE Plan Review and Inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $279 / FACILITY It:F�i�14Ac1 I TANK ID # (s) : I PLAN CHECK FEE = $744 / FACILITY MISCELLANEOUS $ TRANSFER FEE _ $ 20 $ CONSULTATION FEE _ $ 93/ HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR SAMPLING INSPECTION FEE _ $ 93/ HOUR ALL FEES ARE BASED ON THE $93 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. OFFICE USE ONLY SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED SR EH 23 032 (REVISED 02122105)