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Apr 07 08 10:58a Sandra Barnhart 20984.58586 p.8 <br /> 0 <br /> SAN JOAQUIN COUNTY <br /> EwRONmENTAL HEALTH DEPARTMENT <br /> 600 East blain Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:wvvw.sjg-ov.org/ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> jiC 0-- iJ� S h i f-- 3-utLCL, <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> va 19(A <br /> CITY STATE ZIP CODE I #OF TANKS AT SITE <br /> APPLICANT BIIL ING NAMEA r(1 PPLICANT CONT T NYAM/E� <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> Sal r cl .y.rdr, qf) 'K 9ST b <br /> CITY 1,1 STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> Clime installation eeipa" Retrofit <br /> ACTIVE FACILITY <br /> 2003 2004 2005 2006 2007 2008 <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK(2002-2007) <br /> $550 FEE INCLUDES FACILITY FEE+1 TANK(2003) <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 COPA PROGRAM=S24.0D!FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID# s CLOSURE FEE=$2941 TANK #TANKS X$294= <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID#'(s)' I TEMPORARY CLOSURE FEE_$2941 FACILITY <br /> INSTALLATION PLAN CHECK <br /> Pian Check and Construction Inspections) <br /> TANK ID#(s): PLAN CHECK FEE_$7841 FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(s) <br /> TANK RETROFIT REPAIR FEE =$2941 FACILITY (use for monitoring equipment,cold starts,EVR upgrades, <br /> spill buckets,sumps,mist. <br /> PIPING REPAIR FEE =$2941 FACILITY (use for piping,under-dispenser containment,ect.) <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $20 <br /> CONSULTATION FEE _ $98t HOUR <br /> UNAUTHORIZED RELEASE EVALUATION FEE = S 981 HOUR <br /> SAMPLING INSPECTION FEE _ $981 HOUR <br /> ALL FEES ARE 13ASED ON THE$98 HOURLY RATE. TIME THAT EXCEEDS FEES PAI D WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED I CHECK# I RECEIVED BY I DATE RECEIVED <br /> SR <br /> EH 23 032(REVISED 1201J07) <br />