Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />FACILITY NAME <br />FACILITY CONTACT NAME <br />yob -ego �6 / <br />�i� �'exfon� S9- 8�-3231 <br />FACILITY ADDRESS <br />SITE PHONE # WITH AREA CODE <br />12/0 F a�,��jV GN <br />! ?t 7 7-/- -`2 7 <br />CITY I <br />STATE <br />ZIP CODE <br /># OF TANKS AT SITE <br />StoCL AGN <br />I CA <br />9S'20�1 <br />1 J <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />C� ef�0C r,► <br />2005 <br />APPLICANT MAILING ADDRESS <br />APPLI ANT PHONE # WITH AREA CODE <br />0 &k zl�Z 3 <br />! ?t 7 7-/- -`2 7 <br />CITY <br />STATE <br />ZIP CODE <br />CIRCLE WORK TO BE DONE <br />CONTRACTOR ICC # <br />GA 8S <br />ra <br />96010 <br />Closure InstallatioRepai Retrofit <br />SCJ 07 <br />ACTIVE FACILITY " iv <br />l b ✓ v <br />CLOSURE FEE = $366 / TANK <br />2005 <br />2006 <br />2007 <br />2008 <br />2009 <br />2010 <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK (2005-2007) <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 122 / HOUR <br />SAMPLING INSPECTION FEE _ $ 122/ HOUR <br />$550 FEE INCLUDES FACILITY FEE + 1 TANK (2008-2010) <br />$ <br />$125 PER TANK AFTER FIRST TANK <br />TANK PENALTY ASSESSED <br />TANK SURCHARGE = $15 / TANK <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$49.00/ FACILITY <br />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # (s): <br />CLOSURE FEE = $366 / TANK <br />74 TANKS X $366 = <br />TEMPORARY CLOSURE <br />Plan Review and Inspections) <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = $366 / FACILITY <br />INSTALLATION PLAN CHECK <br />Plan Check and Construction Inspections) <br />TANK ID # (s) : PLAN CHECK FEE = $976 / FACILITY <br />REPAIR PLAN CHECK <br />TANK ID # (s) : <br />TANK RETROFIT REPAIR FEE _ / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, <br />spill buckets, sumps, misc. <br />CONSULTATION FEE _ $ 122/ HOUR <br />PIPING REPAIR FEE = $366 / FACILITY use for piping, under -dispenser containment, ect. <br />MISCELLANEOUS <br />TRANSFER FEE _ $ 25 <br />CONSULTATION FEE _ $ 122/ HOUR <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 122 / HOUR <br />SAMPLING INSPECTION FEE _ $ 122/ HOUR <br />ALL FEES ARE BASED ON THE $122 HOURLY RATE. TIME THAT tXattDs Fees FAIU WILL tit biLLEU TO Ar <br />OFFICE USE ONLY <br />SERVICE REQUEST # I FACILITY ID AMOUNT RECEIVED I CHECK # I RECEIVED BY I DATE RECEIVED <br />SR <br />EH 23 032 (REVISED 07/21110) <br />