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08,/29/2005 15:43 20946434 VALUED ENGINEERING PAGE 04 <br /> • SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL I-IF-ALTi-i DEPARTMENT <br /> 304 East Wcbcr Avcnuc,3"Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax(5'floor):(209)468-3433 Web:www.sjKov.qrF-'fghd <br /> FACILITY NAME PACILITY CONTACT NAME <br /> FACILITY ADDRESS SITE PHONE P WITH AREA CODE <br /> 1611 h - (A ) �-7?p 1 <br /> ICITY STATE ZIP CODE 0 OF TANKS AT SITE <br /> 5 6 <br /> CA q62-22 j <br /> 1vi,k4vi <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> vi) VR <br /> APPLIC—ANT MAILNG ADDRESS APPLICANT PHONE 0 WITH ARIA CODE <br /> AM, <br /> CITY, StkftZiFCODE CIRCLE WORK TO BE DONX,-, <br /> CONTRACTOR ICC;f <br /> CA- <br /> Closure Install*loi Repalk/R,I g�lza 5z,5;1zjq-U11 <br /> ACTIVE FACILITY <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK 2000 2001 2002 2003 2004 2005 <br /> $125 PER TANK AFTER FIRST TANK <br /> TANK PENALTY ASSESSED <br /> TANK SURCHARGE=$15 1 TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALRF-AOY ON INVENTORY IN A CUPA PROGRAM=$24,00/FACILITY <br /> PERMANENT CLOSURE <br /> oarnaval or PorMiftd CIDsure in Plum) <br /> TANK ID i(a); CLOSURE FEE=$2791 TANK #TANKS X$279= $ <br /> TEMPORARY CLOSURE <br /> (Plan Review and Inspections) <br /> TANK ID#(s): - TEMPORARY CLOSURE FEE $2791 FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> (Elan Check and Consiniction In actions <br /> TANK ID#(s): PLAN CHECK FEE $7441 FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#,(2); <br /> TANK RETROFIT REPAIR FEE z$279/FACILITY (u : <br /> se tor njoniloNnq i men,5 f u a& n au $ <br /> _jgR <br /> PIPING REPAIR FEE _$279 i FACILITY use for i2q,underdispenser containment,ea) <br /> MISCELLANEOUS <br /> TRANSFER FEE = S20 $ <br /> CONSULTATION FEE a $931 HOUR <br /> UNAUTHORIZED RELEASE EVALUATION FEE -t $93/HOUR <br /> SAMPLING INSPECTION FEE _ $93/HOUR $ <br /> ALL FEES ARE BASED ON THE"3 HOURLY RATE. TIME THAT EXCEEDS PENS PAID WLL BE IMILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNTRECEIVW CHECKO RECEIVE13 BY DATE RECEIVED. <br /> SR <br /> 0?J 032 QMMSED 02MM <br />