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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTM <br />600 East Main Street, Stockton, CA 95202-3 --4 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.or /g ehd <br />• FACILITY N MEA TY CONTACT NAME <br />/® _ 4 Ir s <br />W1 <br />STATE <br />CA <br />P <br />TANKS AT <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 BASED ON THE $98 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br />OFFICE USE ONLY <br />MAILIN DRES <br />APPLICANT PHONE # WITH AREA CODE <br />TATE <br />ZIP CODE <br />CIRCLE ORK TO BE DONE <br />CONTRACTOR ICC # <br />Closure Installation Repair Retrofit <br />ACTIVE FACILITY <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK (2002-2007) <br />2002 <br />2003 <br />2004 <br />2005 <br />2006 <br />2007 <br />$550 FEE INCLUDES FACILITY FEE + 1 TANK (2008 & New <br />Installs as of 8/1/07) <br />$ <br />$125 PER TANK AFTER FIRST TANK <br />TANK PENALTY ASSESSED <br />$ <br />TANK SURCHARGE = $15 / TANK <br />$ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$24.00/ FACILITY <br />$ <br />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # (s): <br />TEMPORARY CLOSURE <br />CLOSURE FEE = $294 / TANK ]:::#�TANKSX <br />$$294 = <br />$ <br />(Plan Review and Inspections) <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = $294 / FACILITY <br />$ <br />INSTALLATION PLAN CHECK <br />(Plan Check and Construction Inspections) <br />TANK ID # (s) : <br />PLAN CHECK FEE =-$784 / FACILITY <br />$ <br />REPAIR PLAN CHECK <br />TANK ID # (s): <br />TANK RETROFIT REPAIR FEE = $294 / FACILITY (use for monitoring equipment, spill buckets, tank sumps, mise) <br />$ <br />PIPING REPAIR FEE = $294 / FACILITY (use for piping, under -dispenser containment, ect.) <br />$ <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 BASED ON THE $98 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br />OFFICE USE ONLY <br />