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.. BAN JOAQUIN COUNTY <br /> 4 ENVIRONMENTAL HEALTH D.EPARTMENi✓ Ota <br /> - 600 Beast--Main Street,-9toc)ctgtl-eA`95202 3029 --_ r <br /> — -�elepho"e:(209)-4GS3420I+'a 1209x468 :wvnv.m¢ov.or <br /> - -- <br /> I FACILITY NAME -- • - <br /> ..;.; . , •.• ::- .:� ,_.., _ 9 :-CCIN7` CT NAME - .: . <br /> - FACILI- AD RESS. <br /> N„ H 1r", HON@#WITHAREA CODE - <br /> . - <br /> '---�-. <br /> . .. .-. •�- - - O -A KS-AT-91TE.. - <br /> APPCANT CONTACT NAME <br /> _- -_. ' _ _' P.LICANTMAILING-A bRE$&- "•�•a-•.--.;. _ . � __ T <br /> -. <br /> teFLI�N <br /> v T PHONE#WITH AREA CODE- <br /> 25 WiUlit� �Yl_ <br /> 13E DONE <br /> _.......... <br /> TIVE?FACILITY. <br /> _.._..._' <br /> $ FEE INCLUDES FA CIL -- 2006--2007: 2008":—2009 X010— " <br /> SQO. ITY FSE+.1 TANK(2008.2007) 2011 <br /> $550 FEE INCLUDES FACILITY FEE+.1 TANK(2008.2011) . <br /> .,. . . $125 PER TANK AFTER FIRST TANK - •: - <br /> TANK PENALTY ASSESSED <br /> TANK SURCHARGE=$15/TANK .. $ <br /> STATE SURCHARGE FOR 9'ACILI EST'ALREADY ON INVENTORY IN A CUPA PROGRAM 49.001 FACILITY <br /> PORMANENi CLO$OR -----• .._ _._:_,.. <br /> Remb4al or Permitted Closure <br /> TEMPORARY CLOS RE CLOSURE FEE'-$375/TANK : #TANKS X$375- $" <br /> Plan Revlaw and Ins ec8ons <br /> _.__.. <br /> TANK ID <br /> .- ....- -.-"" '78MPORARYCLOSUItE FEE_$'d751 FACILITY <br /> - INSTALLATION PLAN CHECK - <br /> �-•»--' Plan Che6k's3n8'Con`strGono`n <br /> TANK ID#(s) PLAN CHECK FEE_$1 000/FACILITY . <br /> �.. <br /> r. <br /> REP IRPLAN CHECK ... . <br /> TAW.ID fla <br /> K R OF]T REPAIR'FEE $875/FACILrTY (use for monitorinaqui meet,col— d starts.,EVR updes'. --" <br /> -,a ulk a mist. <br /> PIPING <br /> REPAIR FEE $375/FACILITIY sae for I fn' undetrdis'9nser contelnment act. $ - <br /> ..,...., ,...,.,... .,.,.. ...e..�:,.;..:.:. ... <br /> - . . .TRANSFFJi'FEE 25 <br /> ._�- A26/440NR--•-�•- - -- <br /> ....,o..�.` .. <br /> GINSPECTlOp4 ..- - ---- <br /> . <br /> x RNK-a1R8 A86 1 /HOUR T . <br /> _. HE;iII CURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> TRAI.AMOu <br /> Rvies LEST# FACILITYID AMOUNT RECEIVED - <br /> CHECK RECE1vED BY: DATE RECEIVED - - <br /> H IIa 083,1{r€.YL4ER 0011111 by KF) -- <br /> i <br />