COMPLIANCE INFO_2005-2010 - Laserfiche WebLink

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SAN JOAQUIN COUNTY 0 ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.ora/ehd FACILITY NAME FACILITY CONTACT NAME U FM W D SA CC4S S. C FACILITY ADDRESS SITE PHONE # WITH AREA CODE It) 'Z - 3111 CITY STATE ZIP CODE I # OF TANKS AT SITE rtr'?Pi� M CA i1-3 Closure Installation R air Retrofit APPLICANT BILLING NAME APPLICANT CONTACT NAME CLOSURE FEE = $315 / TANK FM W D SA CC4S S. C APPLICANT MAILING ADDRESS APPLICANT PHONE #/W//ITH AREA CODE 2007 ®(W `/ CITY STATE I ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # rtr'?Pi� M CA- 1q4004 Closure Installation R air Retrofit ACTIVE FACILITY TANK ID # (s): CLOSURE FEE = $315 / TANK 2004 2005 2006 2007 2008 2009 $500 FEE INCLUDES FACILITY FEE + 1 TANK (2004-2007) $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 105 / HOUR $ SAMPLING INSPECTION FEE = $ 105/ HOUR $550 FEE INCLUDES FACILITY FEE + 1 TANK (20o',8-200,9) $ $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 INSTALLATION PLAN CHECK TANK ID # (s) : PLAN CHECK FEE = $840 / FACILITY REPAIR PLAN CHECK TANK ID # (s) : $ TRANSFER FEE _ $ 20 $ TANK RETROFIT REPAIR FEE = $315 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, $ spill buckets, sumps, misc.)/ PIPING REPAIR FEE = $315 / FACILITY (use for piping, under -dispenser containment, ect.) $ 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 TO APPLICANT. OFFICE USE ONLY SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED SR tH 23 03Z (KtVIStU 03/20109)