Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT.Y,, <br /> 1868 E.Hazelton Ave., Stockton,CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sj o v.or /g ehd <br /> FACILITY NAME nn FACILITY CONTACT NAME <br /> C� <br /> S�7 TD A <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> STocX v CA 9IT-,? C5 3 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Pte' A'.SO nl 9Y)7_>RA UCJ CS ) <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> ) G,573 W,, ZL. 5-&;�C»vC7© Z )a 6 2 7-r>sa3 <br /> CITY STATE I ZIP CODE CIRCLE WORK TO BE DONE I CONTRACTOR ICC# <br /> Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> 2008 2009 2010 2011 2012 20 <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK(2008) <br /> $550 FEE INCLUDES FACILITY FEE+1 TANK(2009-2013) t <br /> $125 PER TANK AFTER FIRST TANK $ <br /> TANK PENALTY ASSESSED <br /> TANK SURCHARGE=$15/TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$35.00/FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID#(s): CLOSURE FEE=$375/TANK #TANKS X$375= <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID#(s): - TEMPORARY CLOSURE FEE =$375/FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> TANK ID#(s): PLAN CHECK FEE=$1000/FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <br /> TANK RETROFIT REPAIR FEE =$375/FACILITY (use for monitoring equipment,cold starts,EVR upgrades, <br /> spill buckets,sumps,misc. <br /> PIPING REPAIR FEE _$375/FACILITY use for piping,under-dispe ct. <br /> MISCELLANEOUS RECEIVED <br /> TRANSFER FEE _ $25 APR 10 2014 $ <br /> CONSULTATION FEE _ $125/HOUR SAN JOAQUIN COUNTY $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $125/HOUR HEALTH DEPARTMENT $ <br /> SAMPLING INSPECTION FEE = $ 125/HOUR $ <br /> ALL FEES ARE BASED ON THE$125 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> TOTAL AMOUNT DUE O <br /> OFFICE USE ONLY 14 <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RFCEIVED <br /> irl I C,/ �� 11 11,91/12 <br /> EH 23 032(REVISED 04/30/13 by RvF) <br />