COMPLIANCE INFO_2008-2011 - Laserfiche WebLink

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• SAN JOAQUIN COUN'I'l • FNIVIRONMENfAI.I IFAI:I'II DvIIARTMIXI. 600 Gast Main Street,Stockton,CA 95202-3029 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.s*'2,ov.org/9I1d FACILITY NAME FACILITY CONTACT NAME _ rkq wv►t Z O g LL g FACILITY ADDRESS SITE PHONE#WITH AREA CODE CIT, _ STATE ZIP CODE #OF TANKS AT SITE S 4-0 CA Ci 5 Zl -7- APPLICANT APPLICANT BILLING NAME APPLICANT C014TACT NAME _ nJ Loi u 1b L� 5 4 (I"Ldt-�)tj- 2 APPLICANT MAILING AdbRESS APPLICANT PHONE#WITH AREA CODE ///b W l4,C r.•r LN 5k '37-3 S� ?y`t 1110 S'-I CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# Lo c l•.. C*, 7SZLCb Closure Installation e ai Retrofit ACTIVE FACILITY - 2004 2005 2006 2007 2008 2009 $500 FEE INCLUDES FACILITY Y FEE+ 1 TANK(2004-2007) $550 FEE!NCLUDFS FACILITY FEE+1 TANK(2003.2009) $ $125 PFR 'SANK AFT FR FIRST TANK TANK PEN4LTY ASSESSED TANK SUPCHARGE=$15/TANK STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$49.00/FACILITY PERMANENT CLOSURE (Removal ,r Permitted Closure in Placer ----- - TANK ID (s)' CLOSURE FEE=$345/TANK #TANKS X$345= __ TEMPORARY CLOSURE Plan Review and Inspections) $ TANK IFS#(s): TEMPORARY CLOSURE.FEE_$345/FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Inspections) _ PLAN CH -- $ TANK ID"(s) CHECK FEF-$920/FACILITY REPAIR P_AN CHECK _ __TA K ID#(s): TANK RF?ROFIT REPAIR FEE =$345/FACILITY (use for monitoring equipment,cold starts,EVR upgrades, spill buckets,sumps•mrsc) _ _ PIPING REPAIR FEE _$345/FACILITY (use for piping,,under-dispenser containment,ect.) MISCELLANEOUS $ TRANSFER FEE _ $20 CONSUL i ATION FEF = $115/HOUR -- UNAUTHORITF.I)RELEASE EVALUATION FEE _ $115/HOUR _-_ $ SAMPLING INSPECTION FEE _ $115/HOUR ALL FEES ARE BASED ON THE 5115 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. OFFICE USE ONLY SERVICE R=QUEST# FACILITY ID AMOUNT RECEIVED CHECK# I RECEIVED BY DATE RECEIVED SR EH 23 032(REVISED 07/01/09)