COMPLIANCE INFO_2005-2010 - Laserfiche WebLink

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SAN JOAQ UIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sjgov.org/ehd FACILITY NAME APPLICANT CONTACT NAME FACILITY CONTACT NAME Vglerp 4 '5&41 (ftae-m) (on Sic r^2r%2,1cr) FACILITY ADDRESS 707 70 -1 60 a& 107 SITE PHONE # WITH AREA CODE I Z 1 o f✓ • 142Lrn m cr (.ten e, " 477 - 3111 CITY pe,ta1u►�s I STATE I ZIP CODE I # OF TANKS AT SITE 5+0c. k+on ICA 1 95210 3 APPLICANT BILLING NAME APPLICANT CONTACT NAME �nfGG F-2(12 6(2nino proj. r• APPLICANT MAILING ADDRESS APPLICANT PHONE #WITH AREA CODE 113? H. he -Dm -x--11 Blwl • 707 70 -1 60 a& 107 CITY STATE I ZIPCODECIRCLE WORK TO BE DONE CONTRACTOR ICC # pe,ta1u►�s GA 84454 Closure Installation Repair Retro $550 FEE INCLUDES FACILITY FEE + 1 TANK (2009) ACTIVE FACILITY TANK ID # (s): CLOSURE FEE= $315 /TANK 2004 2005 2006 2007 2008 2009 $500 FEE INCLUDES FACILITY FEE + 1 TANK (2003-2008) $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 105 / HOUR $ SAMPLING INSPECTION FEE = $ 105/ HOUR $550 FEE INCLUDES FACILITY FEE + 1 TANK (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 Check and Construction TANK ID # (s) : I PLAN CHECK FEE = $840 / FACILITY REPAIR PLAN CHECK TANK ID # (s) : TANK RETROFIT REPAIR FEE = $315 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, spill bu ets, sumps, misc. _ii-- 15 7.5D Rus 56"' ca -Fac PIPING REPAIR FEE = $315 / FACILITY T use for i in , under-dis enser containment, ect. $ $47Z 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 EH 23 032 (REVISED 02/23/09)