Laserfiche WebLink
MJ1Z-Li<00b 1tat)4 4548138 ENVZRtNMN-TAL HEALTH PAGE 01 <br /> SkN JOAQUM COUNTY <br /> ENVIRONMENTAL HEALTH DEPA1tTl'"T*08 304 East Weber Avenue.3'd Floor,Stodton,CA 452 <br /> TekWhorre:(209)458-3420 Fes ff'h floor):(204)46$-3433 Weh:www.s ov.or c1u3 <br /> FACILITY NAME FACILFFY CONTACT NAME <br /> FACILMYAADDRE SITE PHONE#WTTH AREA CODE � ^ <br /> C STATE ZIP CODE #CIF TAN AT SITE <br /> CA + <br /> APPLICANT BILLING NAME LICANT CONTACT N *'E - <br /> 1 QN <br /> APPLtGANT MAILING ADDRESS <br /> APPLICANT PHONE X VIfIT EA CODS <br /> CITY STATE ZIP COQ CIRCLE WqRk!Q.PE DONE CONTRACTOR ICC 0 <br /> Gloaura inste RePN, I trn4t <br /> ACTIVE FACILITY 1" <br /> 501 ___i002 2003 2004 2005 20136 <br /> 5500 FEE INCLUDES FACILITY FEE+1 TANK <br /> 4125 PER TANK AFTER FIRST TANK $ <br /> TANK PENALTY ASSESSED <br /> TANK SURCHARGE=S15/TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$24.001 FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Peace $ <br /> GS X$285= <br /> TANK ID#(S).: CLOSURE FEE=52851 TANK ak TA <br /> T)EMFORARY CLOSURE <br /> tan Revinwand in dons $ <br /> ---TANK ID 0(s) TEMPORARY CLOSURE FEE=V85/FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and ConstmClirm In ctions <br /> TANK 10#(s); PLAN CHECK FEE=5760 I FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): }_ <br /> —_� .— _._.. - mise. 1�3 <br /> TANK RETRPFTT REPAIR FEE =$2851 FACILITY use for monilodn I sill buckets.tank gum $ <br /> PIPING REPAIR FEE C$2851 FACILITY use for PON.u encer Cantainn-nt,ML <br /> MISCELLANEOUS <br /> $ <br /> TRANSFER FEE = S 20 $ <br /> COINSULTAfiiUN <br /> UNAU114DRiZEO RELEASE F VALLIATK)N FEE = S 951 HOUR $ <br /> SAMPLING MI PECT1ON FEE = 5 951 HOUR <br /> .ALL FEES ARE SASE E THE flf5 HDURLY RATE Ir i THAT I:7CCEEDS FEES PAID WILL BE 9tLt Eta TO AEPUCANT- <br /> OFFICE USE ONLY <br /> SSRVlGE REgt1EST FACILITY m gbttF"Kh_UeJ/ED CHECK 1! RECEIVED BY PATE RECEIVED <br /> SIR <br /> EH 23 032(REVISED 07121M) <br />