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SAN J O AQ U I N Environmental Health Department <br /> COUNTY <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Verizon Business. LDIKCA Zachary D Fein old <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 2500 W Turner Rd 909 879-2712 <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> Lodi CA 95242 1 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> 5unwest Engineering Constructors, Inc Vanessa Ortega <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 4780 Cheyenne Wa 909 594-9830 Ext 8014 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> Chino CA 91710 Closure Instal atiol Repair Petrofit <br /> ACTIVE FACILITY <br /> UST FEES= $550 2013 2014 2015 UST FEES= 2016 UST FEES= 2017 2018 <br /> (Facility+1st Tank)+ $583 Facility+ $641 Facility <br /> $130rTank after 1st $1391rank +$152/Tank $ <br /> Tank Penalty Assessed for $ <br /> Unreported Tanks(Based on <br /> Annual Permit Fees <br /> $ <br /> TANK SURCHARGE-$201 TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$49.001 FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> $ <br /> TANK ID#(s): CLOSURE FEE=$4561 TANK #TANKS X$456= <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections <br /> $ <br /> TANK ID#(s); TEMPORARY CLOSURE FEE=$4561 FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> $ <br /> TANK ID#(s): PLAN CHECK FEE=$1,216 1 FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): 390002325070250701 <br /> TANK RETROFIT REPAIR FEE =$456 1 FACILITY (use for monitoring equipment,cold starts,EVR upgrades, <br /> spill buckets,sumps,misc.) 456.0 <br /> PIPING REPAIR FEE=$4561 FACILITY use for piping,under-dispenser containment,ect. <br /> MISCELLANEOUS <br /> TRANSFER FEE = $25 $ <br /> CONSULTATION FEE = $1521 HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $1521 HOUR $ <br /> SAMPLING INSPECTION FEE = $1521 HOUR $ <br /> FEES ARE BASED ON THE$152 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> TOTAL AMOUNT DUE $ <br /> OFFICE USE ONLY <br /> SERVICE REQUESTS FACILITY ID AMOUNT RECEIVED CHECK it RECEIVED BY DATE RECEIVED <br /> 1868 E. Hazelton Avenge I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />