Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTF(DEPARTMENT <br /> 600 East Main.sired,Stockton,CA 05202-3023 <br /> Telephone:(209)468»3420 Fax:(209)468-3433 Web:wMMgjabv.ordckd <br /> FACILITY.NAME �^ FACILITY CONTACT NAME <br /> ��„ LEsCO t' W' <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 2 oZ VjA;j 14 1N1,rw4 ST <br /> CITY I STATE ZIP CODE #OF TANKS AT SITE <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> we STS . 3:q4 M 4-f t P t sc-:- w <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 2 25 (vRrTtAAAS ?A*lL D ft 3SO r--1131 <br /> CITY STATE I ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> r Instmiadon Re it Retrofit <br /> ACTIVE FACILITY <br /> 2006 2007 2008 2009 2010 2011 <br /> $500 FEE INCLUDES FACILITY.FEE+1 TANK(2006-2007) <br /> $550 FEE INCLUDES FACILITY FEE.+ i TANK(200&2011) $ <br /> $123 PER TANK AFTER FIRST TANK <br /> TANK PENALTY ASSESSED <br /> TANK SURCHARGE= 15.1 TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM#S49.0t11 FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure In Place <br /> TANK 1D#(s): 'TA Nx A CLOSURE FEE=5375 i TANK #TANKS X 375 <br /> TEMPORARY CLOSURE <br /> Pian Review and Ins tions <br /> TANK 10#(s) TEMPORARY CLOSURE FEE_$3751 FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Ins ecdons <br /> TANK ID#(s): PLAN CHECK FEE_$1,0001 FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(s) <br /> TANK RETROFIT REPAIR FEE _$3751 FACILITY(use for monitoring equipment,cold starts,EVR upgrades, <br /> s 0 bucket surn mist. <br /> PIPING REPAIR FEE_$3751 FACILITY use for alng,under4sonser containmen Oct <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $25 $ . <br /> CONSULTATION FEE - 1251 HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE S 1251 HOUR I $ <br /> SAMPLING ENSRECTION FEE 1251 HOUR $ <br /> ALL FEES ARE BASED ON THE$126 HOURLY RATE:TENS THAT EXCEEDS FEES PAID mLL SE BILLED TO APPLICANT. <br /> TOTAL AMOUNT DUE $37S <br /> OFFICE USE ONLY <br /> SERVICERE60ESTS FACILITYID AMOUNTRECEIVED I CHECK# I RECEIVED BY I DATE RECEIVED <br /> EH 23 032(REVtSED OQ11111 by KF) <br />