Laserfiche WebLink
S A N s1 O A Q U N Environmental Health Department <br /> COUNTY <br /> P' Greatness grows here , <br /> FACILITY NAME FACILITY qONTACT NAME <br /> ( %4 S Pe wFt4c0 A M per, ,Jesse r add4- <br /> FACILITY ADDRESSt SITE PHONE # WITH AREA CODE <br /> 1 16 o S. /'1 a, (M S� ( Zo4 ) 8 Z� - 6 r+ ? y <br /> CITY STATE ZIP CODE # OF TANKS AT SITE <br /> QiLp Aece- CA Coq- (9 532 791� 3 <br /> APPLICANTIMBILA` PL jLING1e �� f� l� ` APPLICAN LONTAFTN/1ME � r � � <br /> > A4&4 <br /> APPLICANT AILING ADDRESS APPLICANT PHONE WI AREA CODE <br /> 1 C� o - v8o <br /> CITY STATE ZIP CODE CIRCLE K TO BE DONE CONTRACTOR ICC # <br /> 04 V, -1` 4 d CM It sln Ciosu epair Retrofit 5,2. 0 4e/.57 ( <br /> ACTIVE FACILITY <br /> UST FEES = $550 2014 2015 UST FEES 2016 UST FEES 2017 VPH UST FEES = 2018 $ <br /> (Facility+1st = $563 = $641 $961 Facility + <br /> Tank) + $130rrank Facility + Facility + $226rrank <br /> after 1st $139/Tank $152/1rank <br /> Double Wall & 1702 $ <br /> Compliant UST <br /> FEES = $680 <br /> Faclli + $228rrank <br /> Tank Penalty $ <br /> •Assessed for <br /> Unreported Tanks <br /> (Based on Annual <br /> Permit Fees <br /> TANK SURCHARGE _ $20 f TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$49001 FACILITY $ <br /> PERMANENTCLOSURE <br /> Removal or Permitted Closure In Place <br /> TANK ID # (s) : CLOSURE FEE _ $456 / TANK # TANKS X $456 = $ <br /> TEMPORARY CLOSURE <br /> Plan Review and Ins actions <br /> TANK ID # (s) : TEMPORARY CLOSURE FEE = $456 / FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> TANK ID # (s) : PLAN CHECK FEE = $3,040 / FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID # (s) : <br /> TANK RETROFIT REPAIR FEE _ $456 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, $ <br /> Spit) buckets, sumps, misc.)yS6 V <br /> PIPING REPAIR FEE _ $456 / FACILITY use for piping, under-dispenser containment, etc. $ <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $ 25 $ <br /> CONSULTATION FEE _ $ 152/ HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $ 152 / HOUR $ <br /> SAMPRELING INSPECTION FEE _ $ 1521 HOUR $ <br /> FEES ABASED ON TME $152 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> TOTAL AMOUNT DUE <br /> OFFICE USE ONLY <br /> SERVICE REQUEST 0 FACILITY ID I AMOUNT RECEIVED I CHECK C 1 RECEIVED BY I DATE RECEIVED <br /> 1868 E. Hazelton Avenue i Stockton , California 95205 T 209 468-3420 F 209 464=0138 www.sicehd .com <br />