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08/21/2006 15:54 4645138 ENVIRONMENTAL HEALTH PAGE 02 <br /> SAKI JOAQUIN COUN+f 1' <br /> ENVIRONMENTAL HEALTH DEPA RTME'NT <br /> 304 East Weber Avenue,311 Floor,Stocktary CA 95202-2708 <br /> Telephone:(209)458-3424 Fac(P floor):(209)458-3433 Web. www—sjgou.9'g1qhd <br /> FACILITY HAMI; FACILITY CONTACT NAME <br /> FACILITY ADDRESS <br /> 5fTl=PHONE#WITH A E <br /> a44�� N k\ �:, (�I-p 2� <br /> CITY STATE Zip COU1= #OF TANKS AT 517E <br /> CA <br /> APPLICANT BILLING NAME APPLICANT Ci)NTACT NAME <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE*WITH AREA CODE <br /> CITY STATE ZIP COVE CI�1- CONTRACTOR]CC# <br /> Closur <br /> ACTIVE FACILITY <br /> 2001 2002 2003 2004 2005 2006 <br /> 5500 FEE INCLUDES FACILITY FEE+'I TANK <br /> ;125 PER TANK AFTER FIRST TANK $ <br /> TANK PENALTY ASSESSED $ <br /> TANK SURCHARGE w$151 TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAMA-$24.001 FACILITY <br /> PERM UYEKT CLOSURE <br /> E ommal or Permitted Closure in Place <br /> TANK ID# 'S): CLOSURE i~I:E=SZ851 TANK #TANKS X$295 <br /> TEMPORARY CLOSURE <br /> Plan RevlOwand to lions � <br /> - TEMPORARY CLOSURE FEE=5285/FACILITY <br /> TANK ID N(s): <br /> INSTALLATION PEAK CHECK <br /> Plan Check and Construction I cclians 5 <br /> TANK Ip#{s): PLAN CHECK FEE=S76f)I FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID (s): $ <br /> TANK RETROFIT REPAIR FEE =$2851 FACILITY use for►nanitmin F s lu burfceEs,lank sum ,mfsc. <br /> i $ <br /> PIPING REPAIR FEE _$285/FACILITY use for under er cantainmenl,�� <br /> MISCELLANEOUS <br /> TRANSFER FEE = S20 $ <br /> CONSULTATION FES = S 951 HOUR <br /> LINAUTHORIZED RELEASE EVALUATION FEE = 3951 HOUR $ <br /> SAMPLING INSPECTION FEE w 3 451 HOUR <br /> ALL SEES ARE BASED ON THE Si5 HCNIRLY RATE TimE THAT pCCEEDS FEES PAID WELL BE BILLEY7 T4 APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE RSQUI ST• FACILITY 0AMQUNT RECENEtI piEGIC A RECEivI"n BY DATE REGEIYES7 <br /> SR <br /> EH 230321REYISED 072S10E1 <br />