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0 <br /> SA\JOAQt:IN COUNn' <br /> ENVIRONMI.NTAL HEALTI I DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephor►e:(209)468-3420 FILv:(209)468-3433 Web.w S g2�gxg[ehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> V..l -*- <br /> FACILITY ADDRESS SITE PHONE#VNI H AREA CODE <br /> 101 hoc <br /> CITY STATE I ZIP CODE *OF TANKS AT$1 <br /> t CA <br /> A PLICANT BILLING NAME APPLICANT CONTACT NAME <br /> A <br /> APPLICANT MAI ING AD REBS APPLICANT PNONE 0 WITH AREA CODE <br /> t <br /> CITY STATE ZIP C009 CIRCLE WORK TO 06 DONE CONTRACTOR ICC 0 <br /> Closure Installationw RetroM <br /> ACTIVE FACILITY <br /> aaoa zaaS 2006 2007 aooe aaas <br /> S FEE INCLUDES FACILITY FEE+i TANK(2004-2007) <br /> $550 FEE INCLUDES FACILITY FEE+1 TANK <br /> $125 PER TANK AFTER FIRST TANK <br /> TANK PENALTY E_§§ED <br /> TANK SURCHARGE m$151 TALC <br /> STA UftCHARGj FOR FACILITI S NOTA READY ON NT Y IN A C A PR -S24.0W FACILITY <br /> P RMAN NT CLOSURE <br /> R aN or P4rrNtted Closure in Place <br /> TANK t # s : C F $315 t TANK 0 T X$315 <br /> TEMPORARY LOU E <br /> R <br /> S <br /> TANK ID#(s): TEM25MY CLOSURE FEE_$3151 FACILITY <br /> IN ALLATI N PLAN CHICK <br /> Lft!QgLk gnd 92MMgM RMNOWS) <br /> TAW 10#JL): PLAN GH CK FEE=SS40 I FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID 0(s): <br /> S <br /> TANK RETROFIT REPAIR FEE _$3151 FACILITY (use for .cold starts,EVR upgrafts. ! <br /> 'll .sunvsl ROE.) <br /> 5 <br /> PIPs REP+ F E _$315I FACILITY for nt 00 <br /> WHOULANEOUIS <br /> S <br /> M&IF-0F <br /> S <br /> GONS2ULTIONFE = 1122 HOUR <br /> $ <br /> o R UATKN+E F = 114,1HqUIR <br /> S <br /> INSPECTION F = 1 <br /> ALC 6 1 Y RAk A E-IftLIFTOwpom"T. <br /> OFFICE USE ONLY <br /> 0 0 R X IMom <br /> R 0- <br /> SR <br /> KH 23 032( E D !) <br />