COMPLIANCE INFO_2004-2009 - Laserfiche WebLink

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II SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENI 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 Telephone: (209) 468-3420 Fax (5`" floor): (209) 468-3433 Web: www.s' ov.or�/ehd FACILITY NAME FACILITY CONTACT NAME f�, V li11 FACILITY ADDRESS SITE PHONE # WITH AREA COD e AAPPLICANT MAILING ADDRESS CITY I STATE ZIP CODE # OF TANKS AT SITE a c CA $ APPLICANT BILLING NAME Removal or Permitted Closure in Place APPLICANT CONTACT NAME 2000 ` ® �� - 2003 AAPPLICANT MAILING ADDRESS 2005 IC„ANT PHONE # WITH AREA CODE APPLICANT S ® ® $ TANK ID # (s) : ffi "4�i.1/ ”6%80 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICG # v I Closure Installation epair Retrofit ACTIVE FACILITY Removal or Permitted Closure in Place TANK ID # (s): 2000 2001 2002 2003 2004 2005 Plan Review and Ins ions $500 FEE INCLUDES FACILITY FEE + 1 TANK $ TANK ID # (s) : TEMPORARY CLOSURE FEE = $2791 FACILITY $ 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): TANK RETROFIT REPAIR FEE = $279 / FACILITY use for monitoring equipment, spill buckets, tank sumps, misc. $dE TANK ID # (s): CLOSURE FEE = $279 / TANK # TANKS X $279 = TEMPORARY CLOSURE Plan Review and Ins ions $ TANK ID # (s) : TEMPORARY CLOSURE FEE = $2791 FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Inspections) TANK ID # (s) : PLAN CHECK FEE = $744 / FACILITY $ REPAIR PLAN CHECK TANK ID # (s): TANK RETROFIT REPAIR FEE = $279 / FACILITY use for monitoring equipment, spill buckets, tank sumps, misc. $dE PIPING REPAIR FEE = $279 / FACILITY use for piping, under -dispenser containment, ect.) $ MISCELLANEOUS $ TRANSFER FEE _ $ 20 $ CONSULTATION FEE = $ 93/ HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR $ SAMPLING INSPECTION FEE = $ 93/ HOUR ALL FEES AM BASED UPI THE 593 HDUKLY 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 SIR EH 23 032 (REVISED 02/22/06)