Laserfiche WebLink
SAN JOAQUIN C' 'NTY PUBLIC HEALTH SERVICES-ENVIRON"ENTAL HEALTH DIVISION <br /> IJNDERGF, JND STORAGE TANK PROGRAM =E WORKSHEET <br /> FACILITY NAME FACILITY CONTACT NAME <br /> S. T. Srvices John Ridenho <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 3505 Navy Dr. 209 ) 943-5662 <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> Stockton, CA 95206 2 <br /> APPLICANT BILLING NAME I APPLICANT CONTACT NAME <br /> S.T. Services John Ridenhour <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 2941 Navy Dr. 209) 943-5662 <br /> CITY I STATE ZIP CODE CIRCLE WORK TO BE DONE: <br /> Stockton, CA 95206-1149 Closure Installation Repair Retrofit _ <br /> ACTIVE FACILITY <br /> 1996 - 1999 2000 2001 <br /> $500 FEE INCLUDES FACILITY FEE + 1 TANK (S1 70)X(R tanks)X or years applicable) <br /> $125 PER TANK AFTER FIRST TANK $ <br /> TANK PENALTY ASSESSED <br /> $ <br /> TANK SURCHARGE=S8/TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=510/FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place) <br /> TANK ID#(s): CLOSURE FEE=S261 /TANK I :TANKS X S261 = 522 .00 <br /> TEMPORARY CLOSURE <br /> (Plan Review and Inspections) <br /> TANK ID;*(s): TEMPORARY CLOSURE FEE=$261 /FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections $ <br /> TANK ID#(s): PLAN CHECK FEE=$696/ FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): $ <br /> TANK LINING REPAIR FEE =$261 /TANK #TANKS X$261 = <br /> TANK RETROFIT REPAIR FEE =S261 1 FACILITY $ <br /> PIPING REPAIR FEE _$261 /FACILITY <br /> MISCELLANEOUS <br /> TRANSFER FEE = S 20 S <br /> CONSULTATION FEE = S 87/HOUR S <br /> UNAUTHORIZED RELEASE EVALUATION FEE = S 87/HOUR <br /> SAMPLING INSPECTION FEE = S 87/HOUR <br /> ALL FEES ARE BASED ON THE$87 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST$ FACILITY ID AMOUNT RECEIVED CHECK x RECEIVED BY I DATE RECEIVED <br /> ISR <br />