Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />` Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FACILITY NAME <br />FACILITY CONTACT NAME <br />CLOSURE FEE = $315/TANK <br />C�f.-'4l4 f a � 4 7�: <br />�� � � �C Y VL S <br />T _ t <br />� 4ry tilt S \ L'3 e C"k <br />FACILITY ADD ESS <br />SITE PHONE # WITH AREA CODE <br />PIC,. 14,) e&ttll 'u N410 'E1VCJ- <br />201 'I Y.3 `Zvgz <br />(1/6) 267 - <br />CITY <br />STATE <br />ZIP CODE <br />#/SOF TANKS AT SITE <br />ICA <br />Closure Installation Repai, Retrofit <br />5 Z 3Y7 72 <br />$550 FEE INCLUDES FACILITY FEE + 1 TANK (2008) <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />CLOSURE FEE = $315/TANK <br />,,Jjj <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />2006 <br />2007 <br />CITY <br />STATE <br />I ZIP CODE <br />CIRCLE WORK TO BE DONE <br />CONTRACTOR ICC # <br />. C., 1E` i i ; <br />1('4 <br />1,75c? <br />Closure Installation Repai, Retrofit <br />5 Z 3Y7 72 <br />M <br />He <br />ACTIVE FACILITY <br />TANK ID # (s): <br />CLOSURE FEE = $315/TANK <br />2003 <br />2004 <br />2005 <br />2006 <br />2007 <br />2008 <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK (2002-2007) <br />$ <br />PIPING REPAIR FEE = $315/FACILITY use for piping, under -dispenser containment, ect.) <br />$ <br />SAMPLING INSPECTION FEE _ $ 105/ HOUR <br />$550 FEE INCLUDES FACILITY FEE + 1 TANK (2008) <br />$ <br />$125 PER TANK AFTER FIRST TANK <br />TANK PENALTY ASSESSED <br />$ <br />TANK SURCHARGE = $15/TANK <br />$ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$24.00/ FACILITY <br />$ <br />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # (s): <br />CLOSURE FEE = $315/TANK <br /># TANKS X $315 = <br />TEMPORARY CLOSURE <br />Plan Review and Inspections) <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = $315/FACILITY <br />PLAN CHECK <br />Construction Ir <br />TANK ID # <br />PLAN CHECK FEE = $840/FACILITY <br />REPAIR PLAN CHECK <br />$ <br />TANK ID # (s) : <br />TRANSFER FEE _ $20 <br />TANK RETROFIT REPAIR FEE = $315/FACILITY (use for monitoring equipment, cold starts, EVR upgrades, <br />-,,,sumps, <br />��- <br />spill buckets s, misc.) <br />$ <br />$ <br />PIPING REPAIR FEE = $315/FACILITY use for piping, under -dispenser containment, ect.) <br />MISCELLANEOUS <br />$ <br />TRANSFER FEE _ $20 <br />$ <br />CONSULTATION FEE = $105/HOUR <br />$ <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 105/1-10UR <br />$ <br />SAMPLING INSPECTION FEE _ $ 105/ HOUR <br />--- - --- - --— —,_-- _.. ..._ . ,,.., 11— 1— 1-1— oC 01LLCL! 1 V AP" I-LIL AR 1. <br />OFFICE USE ONLY <br />SERVICE REQUEST # FACILITY I!) AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br />SR <br />EH 23 032 (REV[ 7/18/08) <br />