Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEk <br /> 304 st Weber Avenue,3`'Floor, Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax(5`"floor):(209)468-3433 Web:www.sigov.org/ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> San u nLtt; Far f.,r�%kap Gh�s M , IIu <br /> FACILI ADDRESS SITE PHONE#WITH AREA CODE <br /> 2S9Y5 E HwY a01 60/ - 35` 1 <br /> CITY STATE ZIP CODE I #OF TANKS AT SITE <br /> `ArlM;n }-oh I CA 9'5;QK) 1 One- <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> San u nJ" Yn e �Men�i LLC. Chr Y`1,IIFr <br /> APPLI ANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 1865$ L (209 (001 - -wi 1 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> CA 952--x. osu Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK 2000 2001 2002 2003 2004 2005 <br /> $125 PER TANK AFTER FIRST TANK <br /> $ <br /> TANK PENALTY ASSESSED <br /> TANK SURCHARGE_$15/TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$24.00/FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID#(a): UST — I CLOSURE FEE=$279/TANK #TANKS X$279= $27 9 <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> $ <br /> TANK ID#(a): TEMPORARY CLOSURE FEE_$279/FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> TANK ID#(a): PLAN CHECK FEE_$744/FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(a): <br /> TANK RETROFIT REPAIR FEE =$279/FACILITY (use for monitoring equipment,spill buckets,tank sumps,misc.) <br /> $ <br /> PIPING REPAIR FEE _$279/FACILITY (use for piping,under-dispenser containment,act. <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $20 <br /> $ <br /> CONSULTATION FEE _ $93/HOUR <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $93/HOUR <br /> SAMPLING INSPECTION FEE _ $93/HOUR <br /> ALL FEES ARE BASED ON THE$93 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# I FACILITY ID I AMOUNT RECEIVED I CHECK# I RECEIVED BY I DATE RECEIVED <br /> SR <br /> EH 23 032(REVISED 02/22/05) <br />