Laserfiche WebLink
• <br />C: <br />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 ggoy_ org/ehd <br />FACILITY NAME <br />FACILITY CONTACT NAME <br />QVttL STOP * IZ( <br />2002 <br />FACILITY ADDRESS <br />SITE PHONE # WITH AREA CODE <br />IIq(o I,(1- GouIsrr4vE - <br />�/ro 3�-3 — t/6-7_ <br />CITY <br />I STATE <br />I ZIP CODE <br /># OF TANKS AT SITE <br />m A la T E L A <br />CA <br />1 ! S— 3 3 (0 <br />2 -- <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />'L7- <br />2002 <br />APPLICANT MAILING ADDRESS <br />APPLICANT <br />APPLICANT PHONE # WITH AREA CODE <br />P.0- 30)( /CZE <br />�/ro 3�-3 — t/6-7_ <br />CITY <br />STATE <br />ZIP CODE <br />CIRCLE WORK TO BE DONE <br />CONTRACTOR ICC # <br />(A) , s A -C— <br />C <br />9 S 6 cL t <br />Closure Installation Repair etrofit <br />ACTIVE FACILITY <br />TANK ID # (s): <br />CLOSURE FEE = $294 / TANK <br />2002 <br />2003 <br />2004 <br />2005 <br />2006 <br />2007 <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK (2002-2007) <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 98 / HOUR <br />SAMPLING INSPECTION FEE _ $ 98/ HOUR <br />$550 FEE INCLUDES FACILITY FEE + 1 TANK (2"!08 & Ntt:v <br />$ <br />1107') <br />$125 PER TANKAFTER FIRST TANK <br />TANK PENALTY ASSESSED <br />$ <br />TANK SURCHARGE = $15 / TANK <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$24.00/ FACILITY <br />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # (s): <br />CLOSURE FEE = $294 / TANK <br /># TANKS X $294 <br />TEMPORARY CLOSURE <br />Plan Review and Inspections) <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = $294 / FACILITY <br />ALLATION PLAN <br />Check and Const <br />TANK ID # (s) : I PLAN CHECK FEE = $784 / FACILITY <br />REPAIR PLAN CHECK <br />TANK ID # (s): <br />TANK RETROFIT REPAIR FEE = $294 / FACILITY use for monitoring equipment, spill buckets, tank sumps, misc.) <br />PIPING REPAIR FEE = $294 / FACILITY use for piping, under -dispenser containment, ect.) <br />MISCELLANEOUS <br />TRANSFER FEE _ $ 20 <br />CONSULTATION FEE _ $ 98/ HOUR <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 98 / HOUR <br />SAMPLING INSPECTION FEE _ $ 98/ HOUR <br />ALL FEES ARE BASED ON THE $98 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO Af <br />npme-= "Cr: nmLy <br />SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY I DATE RECEIVED <br />SR <br />EH 23 032 (REVISED 08/3/07) <br />