Laserfiche WebLink
SAN JOAQUIN COUNTY. REG ENVIRONMENTAL HEALTH.LIEPARTMI EIVED <br />1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br />Telephone. (209) 468-3420 Fax: (209) 468-3433 Web: www.sjcehd.com APR 3 0 2015 <br />FACILITY NAMEFACILITY <br />CONTACT NAME <br />a rcc� <br />`M - TltN NM <br />FACILITY. ADDRESS <br />SITE HONE#EUT14 A RFACODE uc ITLIIICODCi <br />1. _ Wadm UN . <br />2(i <br />CITY i <br />STATE <br />ZIP CODE# OF TANKS. AT SITE <br />K Li'l <br />CA <br />APPLICANT BILLING NAME <br />APPLICANT. CONTACT NAME <br />TKO `` <br />2007 <br />APPLICANT MAILING ADDRESS <br />APPLICANT PRONE # WITH AREA CODE <br />5 `7 w 1L(A x) f-1. <br />2011 <br />CITY !1 STATE ZIP CODE <br />CIRCLE WORK TO BE DONE <br />CONTRACTOR ICC # <br />f� <br />Closure Inst atton XpaIr Retrofit <br />MAL <br />eAFhIT <br />ACTIVE FACILITY <br />TANK ID # (s): <br />CLOSURE FEE = $375 / TANK # TANKS X $375. = <br />2007 <br />2008 <br />2009 <br />2010 <br />2011 <br />2012 <br />$ <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK (2007-2008) <br />$ <br />PIPING REPAIR FEE _ $3751 FACILITY use for piping, under-dfs ensercontainment, ect. <br />$550 FEE INCLUDES FACILITY FEE +.1 TANK (2009-2012) <br />$ <br />$125 PER TANK AFTER FIRST TANK <br />$ <br />TANK PENALTY ASSESSED <br />$ <br />_TANK_SURCHARGE..= $15 /TANK... <br />STATE.SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$49.00/ FACILITY I$ <br />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # (s): <br />CLOSURE FEE = $375 / TANK # TANKS X $375. = <br />TEMPORARY CLOSURE <br />Plan.Reviewand Inspections)_ _ <br />TANK.ID.# (s) : <br />TEMPORARY CLOSURE FEE = $375 / FACILITY <br />REPAIR PLAN CHECK <br />TANK ID # (s) : <br />CONSULTATION FEE = 125/ HOUR <br />`TANK RETROFIT REPAIR FEE =3375 / FACILITY (Use for monitoring egUlpment, cold starts, EVR upgrades, <br />$ <br />spill buckets- sums mist,)_ <br />$ <br />_ <br />$ <br />PIPING REPAIR FEE _ $3751 FACILITY use for piping, under-dfs ensercontainment, ect. <br />MISCELLANEOUS <br />TRANSFER FEE _ $ 25 <br />CONSULTATION FEE = 125/ HOUR <br />'UNAUTHORIZED RELEASE EVALUATION FEE _ $125 ! HOUR <br />$ <br />SAMPLING INSPECTION FEE _ $ 125/ HOUR <br />$ <br />RLL Pcc.7 RRC oAOCU Vn Inc i"IL0 nVURLT RAIL. IIIVIC InAI tAI:CCUJ tCCb YAW WILL Ct CILLtU IU APYUCANI. <br />TOTAL AMOUNT DUE $ <br />