COMPLIANCE INFO_2008-2009 - Laserfiche WebLink

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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTME 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.slgov.or /g ehd FACILITY NAME FACILITY CONTACT NAME Aaco ?'O-) 2130 2004 FACILITY ADDRESS SITE PHONE # WITH AREA CODE APPLICANT MAILING ADDRESS IS - 2_ `Z 6? CITY STATE ZIP CODE # OF TANKS AT SITE S4 -v ICA 9 5-z-0 u CIRCLE WORK TO BE DONE CONTRACTOR ICC # APPLICANT BILLING NAME TANK ID # (s): APPLICANT CONTACT NAME 2004 2005 2 -- APPLICANT MAILING ADDRESS 2008 APPLICANT PHONE # WITH AREA CODE $500 FEE INCLUDES FACILITY FEE + 1 TANK (2004-2007) PIPING REPAIR FEE = $315 / FACILITY (use for piping, under -dispenser containment, ect. CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # SAMPLING INSPECTION FEE = $ 105/ HOUR $550 FEE INCLUDES FACILITY FEE + 1 TANK (2008-2009) $125 PER TANK AFTER FIRST TANK i) Closure I a ?I _ epair Retrofit 3 (o ACTIVE FACILITY TANK ID # (s): CLOSURE FEE = $315 / TANK 2004 2005 2006 2007 2008 2009 $500 FEE INCLUDES FACILITY FEE + 1 TANK (2004-2007) PIPING REPAIR FEE = $315 / FACILITY (use for piping, under -dispenser containment, ect. UNAUTHORIZED RELEASE EVALUATION FEE = $ 105 / HOUR $ SAMPLING INSPECTION FEE = $ 105/ HOUR $550 FEE INCLUDES FACILITY FEE + 1 TANK (2008-2009) $125 PER TANK AFTER FIRST TANK $ TANK PENALTY ASSESSED $ TANK SURCHARGE = $15 / TANK STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$24.00/ FACILITY PERMANENT CLOSURE Removal or Permitted Closure in Place TANK ID # (s): CLOSURE FEE = $315 / TANK # TANKS X $315 = TEMPORARY CLOSURE Plan Review and Inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $315 / FACILITY REPAIR PLAN CHECK TANK ID # (s) : $ $ TANK RETROFIT REPAIR FEE = $315 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, )S spill buckets, sumps, misc. CONSULTATION FEE _ $ 105/ HOUR PIPING REPAIR FEE = $315 / FACILITY (use for piping, under -dispenser containment, ect. UNAUTHORIZED RELEASE EVALUATION FEE = $ 105 / HOUR MISCELLANEOUS $ TRANSFER FEE _ $ 20 CONSULTATION FEE _ $ 105/ HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 105 / HOUR $ SAMPLING INSPECTION FEE = $ 105/ HOUR ALL FEES ARE BASED ON THE $105 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED i V APPLICAN L OFFICE USE ONLY SERVICE REQUEST # I ACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED SR EH 23 032 (REVISED 03120109)