Laserfiche WebLink
Dec 07.10 02:43p Reliable PetroleumA 209-845-8953 p.6 <br /> SAN'JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTia DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fat:(209)468-3433 Web:www.sigov.org/ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 110o —s oL vw\ fou ��� - (off?Lj <br /> CITY STATE ZIP CODE <br /> #OF TANKS AT SITE <br /> J " CA QS33 �J <br /> APPLICANT BILLING NAME APPLICANT CONTAC NAME <br /> �e`„�b1e �� Yp1�lAt rVt!e5 yin fieri- f&kYrt[ta�� <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> �S3 (� l Closure Installation epai Retrofrt <br /> ACTIVE FACILITY <br /> VV <br /> $500 FEE INCLUE ES FACiL1TY FEE+ 1 TANK(200-5-2007) 21012006 2007 2008 2009 2010 <br /> $550 FEE INCLUE ES FACILITY FEE+ 1 TANK <br /> $125 PER TANK A FTER FIRST TANK f $ <br /> TANK PENALTY SSESSED $ <br /> TANK SURCHARGE=$151 TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$49.001 FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permi ted Closure in Place <br /> TANK ID#(s): CLOSURE FEE=$3661 TANK #TANKS X$365= $ <br /> TEMPORARY CLC oSURE <br /> (Plan Review and I s ectfons <br /> TANK ID#(s): TEMPORARY CLOSURE FEE_$356!FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Ins ecbons <br /> TANK ID#(s)! S <br /> PLAN C-IECK FEE_$975/FACILITY <br /> REPAIR PLAN CH CK <br /> TANK ID#(s) <br /> TANK RETROFIT F EPAIR FEE =$366 1 FACILITY (use for monitoring equipment,cold starts,EVR upgrades, <br /> spill buckets,sumps.misc.) {� <br /> PIPING REPAIR FE E _$366 1 FACILITY (use for p'. in ,under-dispenser containment,ect.) $ <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $25 $ <br /> CONSULTATION F E = $1221 HOUR $ <br /> JNAUTHORIZED RELEASE EVALUATION FEE = $1221 HOUR $ <br /> SAMPLING INSPECTION FEE = $ 122!HOUR $ <br /> ALL FEES ARE BASED ON THE S122 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICEREQUESTI TY ID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED <br /> SR <br /> EH 23 032(REVISED 7121110) <br />