COMPLIANCE INFO_2006-2011 - Laserfiche WebLink

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SAN JOAQUIN COUNTY 0 ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street,Stockton,CA 95202-3029 Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sjgov.or ehd FACILITY NAME FACILITY CONTACT NAME Quik Stop #121 Debbie Markovich FACILITY ADDRESS SITE PHONE#WITH AREA CODE 1196 W. Louise Ave. 51 445-2282 CITY STATE ZIP CODE #OF TANKS AT SITE Manteca CA 95336 2 APPLICANT BILLING NAME APPLICANT CONTACT NAME Same as above APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# Closure Installation Repair Retrofit ACTIVE FACILITY 2004 2005 2006 2007 2008 2009 $500 FEE INCLUDES FACILITY FEE+1 TANK(2003-2008) $550 FEE INCLUDES FACILITY FEE+1 TANK(2009) $ $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=$315/TANK #TANKS X$315= TEMPORARY CLOSURE Plan Review and Inspections) TANK ID#(s): TEMPORARY CLOSURE FEE_$315/FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Inspections) TANK ID#(s): PLAN CHECK FEE_$840/FACILITY REPAIR PLAN CHECK TANK ID#(s): TANK RETROFIT REPAIR FEE =$315/FACILITY (use for monitoring equipment,cold starts,EVR upgrades, $ 366 spill buckets,sumps,misc. PIPING REPAIR FEE _$315/FACILITY use for piping,under-dispenser containment,ect. MISCELLANEOUS TRANSFER FEE _ $20 CONSULTATION FEE _ $105/HOUR UNAUTHORIZED RELEASE EVALUATION FEE _ $105/HOUR SAMPLING INSPECTION FEE _ $105/HOUR ALL FEES ARE BASED ON THE$105 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. OFFICE USE ONLY SERVICE REQUEST# FACILITY ID I AMOUNT RECEIVED I CHECK# I RECEIVED BY I DATE RECEIVED SR EH 23 032(REVISED 02/23/09)