Laserfiche WebLink
ENY1R0 MENTAL HEA TH.UEPARTMENT ri' • <br />1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: Wmwt.sicehd.cotnHVFL <br />:FACILITY NAME <br />FACILITY CONTACT NAME <br />WT -'M S �17C�i3` <br />2007 <br />FACILI ADDRESS <br />SITE PHONE # WITH AREA CODE <br />110 <br />'—2tkO <br />CITY <br />I STATE <br />ZIP CODE OF T ;F <br />_.:- – <br />GA <br />r t <br />APPLICANT BILLING NAME <br />APPLICANT,CONTACT NAME <br />WT -'M S �17C�i3` <br />2007 <br />APPLICANT MAILING ADDRESS: <br />APPLICANT PHONE # WITH AREA CODE <br />2010 <br />209 . <br />CITY 5 <br />STATE <br />ZIP CODE CIRCLE WORKTO BE DONE CONTRACTOR ICC # <br />' <br />UNAUTHORIZED RELEASE EVALUATION FEE = $1251 HOUR <br />Closure lnstalfatlon R air Retrofit <br />15 <br />NTAL <br />r=AIT <br />ACTIVE FACILITY <br />NWID # (s): <br />CLOSURE FEE = $3751 TANK <br />2007 <br />2008 <br />2009 <br />2010 <br />209 . <br />2012 <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK (2091-2008) <br />UNAUTHORIZED RELEASE EVALUATION FEE = $1251 HOUR <br />'SAMP)INO <br />$ <br />INSPECTION FEE _ , 1251'HOUR <br />$550 FEE INCLUDES FACILITY FEE +.1 TANK (2009-2012) <br />$125 PER TANK AFTER FIRST TANK <br />$ <br />TANK PENALTY ASSESSED <br />_TAMS-SUR-QHARGE.= $1.51 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 />NWID # (s): <br />CLOSURE FEE = $3751 TANK <br />T # TANKS X $375 <br />_TA <br />TEMPORARY CLOSURE <br />_(P an_RPv1aw.nd ins ecbons <br />TANK ID # (s): <br />TEMPORARY CLOSURE FEE = $3751 FACILITY <br />INSTALLATION PLAN .CHECK . <br />Plan Check and Construction Inspections) <br />TANK-ICF7# (s) . <br />PLAN CHECK FEE =$1000 / FACILITY <br />REPAIR PLAN CHECK <br />TANK ID #(s): <br />'TANK73ETROFIT REPAIR FEE =$875/'FACILITY (use for monitoring equipment, cold starts'. EVR upgrades, <br />--___._..__ -s M-bW<etsc sumpsi misc.), ._ .. .. <br />$ - <br />PIPING REPAIR FEE = $3751 FACILITY use for p1ping, under -dispenser containment, ect, <br />$ <br />MISCELLANEOUS <br />—TRANSFER FEE . ..- .$.25 _ <br />$ <br />-CONSULTATION FEE _ $ 1261 HOUR <br />UNAUTHORIZED RELEASE EVALUATION FEE = $1251 HOUR <br />'SAMP)INO <br />$ <br />INSPECTION FEE _ , 1251'HOUR <br />ALL—FEES ARE SASE ON THE 4125HOUKLY RATE. WE I HA f E1Il CCU1 f R ES YAIU WILL GL^ tsll Lqu i O RYYLI( ANI . <br />TOTAL AMOUNT DUE Is <br />"OFFICE QSE-OFI LY <br />=ED <br />04113112 by KF1 <br />