Laserfiche WebLink
SAN JOAQUIN COUN'T'Y <br /> �_4VIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sijzov.org/ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> I FACILITY ADDRESS SITE PHONE#WITH AREA COD <br /> SrQC.� GL R�r1 <br /> Z�I 7p <br /> CITY <br /> STATE ZIP CODE #OF TAN S AT SITE <br /> C 915-1310 To ) <br /> APPLICANT BILLING NAME I APPLICANT CONTACT NAME <br /> APPLICANT MAILING ADDRESS f APPLICANT.PHONE#WIT9 AREA CODE <br /> i 7 <br /> CITY�� STATE ZIP CODE IRCLE WORK TO BE DONE CONTRACTOR ICc# <br /> losure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK(20042007) 2004 2005 2006 2007 2008 <br /> $550 FEE INCLUDES FACILITY FEE+1 TANK(2008-2009) <br /> $125 PER TANK AFTER FIRST TANK <br /> TANK PENALTY ASSESSED $ <br /> TANK SURCHARGE_$151 TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$24.001 FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> co�vc�E 77- a 2 -+a $ <br /> TANK ID# s CLOSURE FEE= 3 !TANK l #TANKS X s-766 <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID#{s): TEMPORARY CLOSURE FEE_$315 1 FACILITY Is <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> TANK ID#(s): PLAN CHECK FEE=$8401 FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID#{s} <br /> TANK RETROFIT REPAIR FEE =$315 1 FACILITY (use for monitoring equipment,cold starts,EVR upgrades, $ <br /> spill buckets,sumps,misc. <br /> =PIPINGEPAIR.FEE _$3151 FACILITY use for piping,under-dispenser containment,ect. $ <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $20 $ <br /> 1 <br /> CONSULTATION FEE $1051 HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $1051 HOUR $ <br /> SAMPLING INSPECTION FEE = $1051 HOUR $ <br /> ALL FEES ARE BASED ON THE$105 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID 1 AMOUNT RECEIVED I CHECK# RECEIVED BY DATE RECEIVED <br /> SR <br /> era��n��mcviccn narvnrnn� <br /> Ii <br />