COMPLIANCE INFO_2007-2009 - Laserfiche WebLink

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' SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 Telephone: (209) 468-3420 Fax (P floor): (209) 468-3433 Web: www.ggov,org/ehd, FACILITY NAME (7n O(C) 4�, I S FACILITY CONTACT NAME FACILITY ADDRESS SITE PHONE # WITH AREA CODE ' 7 b ! 0- /Yid Cit Lcc o d6 9 '-1-2 3 - -7 CITY STATE ZIP CODE # OF TANKS AT SITE 6 CA 9,5-20--7 CONTRACTOR ICC # APPLICANT BILLING NAME APPLICANT CONTACT NAME $500 FEE INCLUDES FACILITY FEE + 1 TANK $125 PER TANK AFTER FIRST TANK �v5&1 I V�A,-, -,2 AP LICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE tol-1 lz - I 3(C S- / 2C -C CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # L0'U G'4 S l 0 Closure nsta I n Repair Retrofit ACTIVE FACILITY TANK ID # (s): $500 FEE INCLUDES FACILITY FEE + 1 TANK $125 PER TANK AFTER FIRST TANK 2002 2003 2004 2005 2006 2007 $ $ TANK PENALTY ASSESSED $ TANK SURCHARGE = $15 / TANK $ STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$24.00/ FACILITY $ PERMANENT CLOSURE Removal or Permitted Closure in Place TANK ID # (s): CLOSURE FEE = $285 /TANK # TANKS X $285 = TEMPORARY CLOSURE Plan Review and inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $285 / FACILITY PLAN and TANK ID # (s) : I PLAN CHECK FEE = $760 / FACILITY I _ REPAIR PLAN CHECK TANK ID# (s): $ TANK RETROFIT REPAIR FEE = $285 / FACILITY use for monitoring equipment, s ill buckets, tank sumps, misc.)$ $ PIPING REPAIR FEE = $285 / FACILITY use for piping, under -dispenser containment, ect. $ MISCELLANEOUS - --- ---- --• •-• •-• ....• ..._......wa TRANSFER FEE _ $ 20 $ CONSULTATION FEE _ $ 95/ HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 95 / HOUR $ SAMPLING INSPECTION FEE = $ 95/ HOUR ALL FEES ARE BASED ON THE S95 Hr)IIRI v Rest Trent TWAT cv^.- -- we....... $ -Q vmlu VVILL at t$ILLtU I V APPLICANT. OFFICE USE ONLY