Laserfiche WebLink
Oct 28 14 02: 41,p ElitWV Contactors 120946342 p. 1 <br /> SAN JOAQUIN]COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM.Il 1' ' <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205- 232 <br /> Telephone.(209)468-3420 Fac:(209)468-3433 Web: l 5weh . m I 1 S MAI <br /> AI <br /> FACILITY NAME FACILITY cONLi.t NAME <br /> ACILITY ADDRE S 'E SITEPKONE#VIII i A I CODE. <br /> CITY I STATE ZIP CODE 1 #OF TANKS AT SITE <br /> CA <br /> APPLICANT BILLING NAME APPLICANT C&Rr ',CT NAME <br /> IT" <br /> iipAiCANT MAILING ADDRESS APPLICANT PHUD 'f#WITH AREA CODE <br /> 1' 9 `1tQf <br /> CITY STATE ZIP CODE CIRCLE WORI TO W9 DOME CONTRACTOR ICC# <br /> Closure Ins Ilato air Retrofit <br /> ACTIVE FACILITY <br /> ' <br /> $550 FEE INCLUDES FACILITY FEE+1 TANK 2009 2010 2011 2012 2013 2014 <br /> $130 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 F R GRAM=S35.DO!FACILITY <br /> PERMANENTCLOSURE - <br /> Removal or Permitted Closure In Place <br /> TANKID# s : CLOSURE FEE-$39017.V '.0 #TANKS X$390= <br /> TEMPORARY CLOSURE <br /> Plan Reviewand Inspections) _ <br /> TANK ID#(s): TEMPORARY CLOSURE 17E ;_$390/FACILITY <br /> INSTALLATION PLAN CHECK <br /> (Plan Ctledc and Construction Inspections) <br /> TANK ID#(s): PLAN CHECK F 1040/FACILITY Is <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <br /> TANK RETROFIT REPAIR FEE =$3901 FACILITY (use for monitoring equipment,tali starts,EVR upgrades, 2nd` <br /> spill buckets,sumps,misc. U`lV <br /> PIPING REPAIR FEE= 390/FACILITY use for ODIN,under-dIs enser col .ainment ect. <br /> MISCELLANEOUS _ <br /> TRANSFER FEE _ $25 _ - $ <br /> CONSULTATION FEE = $1301 HOUR _ $ , <br /> UNAUTHORIZED RELEASE EVALUATION FEE = 130/HOUR _ $ <br /> SAMPLING INSPECTION FEE = $1301 HOUR $ <br /> FEES ARE BASED ON THE$130 HOURLY RATE TIME THAT EXCEEDS FEES PAID WILL BE 131 .ED TO APPLICANT. <br /> TOTA4 AMOUNT DUE $ <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# 1 FACILITY ID I AMOUNT RECEIVED CHECK# e RECEIVED BY DATE RECEIVED <br /> EH 23 032(REVISED 0844-141 � — <br />