COMPLIANCE INFO_2008-2012 - Laserfiche WebLink

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. SAN JOAQLjN Cowry • ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone. (209) 468-3420 Fax: (209) 468-3433 Web: www.sj ov.or /, ehd FACILITY NAME APPLICANT CONTACT NAME FACILITY CONTACT NAME `` - � �D *7 APPLICANT PHONE # WITH AREA CODE FACILITY ADDRESS CMkb -6-13- tIU6 SITE PHONE # WITH AREA CODE STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # CITY STATE ZIP CODE # OF TANKS AT SITE CA �S a \ 5- -2- APPLICANT APPLICANT BILLING NAME APPLICANT CONTACT NAME CLOSURE FEE _ $294 /TANK 2003 APPLICANT MAILING ADDRES APPLICANT PHONE # WITH AREA CODE b a o CMkb -6-13- tIU6 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # Closure Installatio Repair Retrofit ACTIVE FACILITY TANK ID # s CLOSURE FEE _ $294 /TANK 2003 2004 2005 2006 2007 2008 $500 FEE INCLUDES FACILITY FEE + 1 TANK (2002-2007) $550 FEE INCLUDES FACILITY FEE + 1 TANK (2008) $ $125 PER TANK AFTER FIRST TANK 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 _ $294 /TANK # TANKS X $294 = TEMPORARY CLOSURE Plan Review and Inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $294 / FACILITY (Plan Check and TANK ID # (s) : FEE = $784 / FACILITY .REPAIR PLAN CHECK TANK ID#(s): $ old starts, EVR upgrades, TANK RETROFIT REPAIR FEE = $294 / FACILITY (use fo o�sum, spill buck $ �y PIPING REPAIR FEE = $294 / FACILITY (use for piping, under -dispenser containment, ect. $ MISCELLANEOUS TRANSFER FEE _ $ 20 $ CONSULTATION FEE _ $ 98/ HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 981 HOUR $ SAMPLING INSPECTION FEE _ $ 98/ HOUR ccrc w nc s ALL _ _ __ _. ____ �.. ...� ................ .v.. r. • nn� . ••ems. cnvccvu r- - •HILL oc 01"CN 1 V #wr"U% #km 1. OFFICE USE ONLY SERVICE REQUEST # FACILITY 1D AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED SR _ EH 23 032 (REVISED 12/31107►