COMPLIANCE INFO_2009-2015 - Laserfiche WebLink

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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEN 600 East Main Street, Stockton, CA 95202-3029 Telephone. (209) 468-3420 Fax. (209) 468-3433 Web. www.siaov.org/ehd FACILITY NAME FACILITY CONTACT NAME ip(o FACILITY ADDRESS SITE PHONE #WITH AREA CODE qq C) L �✓' CITY STATE ZIP CODE I # OF TANKS AT SITE CA q 52,1 APPLICANT BILLING NAME APPLICANT CONTACT NAME -►-� rvlC-f 2004 APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE i® 4`1 _ 5 -2 0 2— CITY STATE I ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # In V1�/-fr-jt �j Closure Installation epair Retrofit 2 - ACTIVE FACILITY TANK ID # s CLOSURE FEE = $315 / TANK 2004 2005 2006 2007 2008 2009 $500 FEE INCLUDES FACILITY FEE + 1 TANK (2003-2008) $ PIPING REPAIR FEE = $315 / FACILITY use for piping, under -dispenser containment, act. $ 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) : I TEMPORARY CLOSURE FEE = $315 / FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Inspections) 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, act. 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 5105 HOURLY RATE. TIME THAT EEGEEUS FEES PAID WILL BE BILLED I V AFF LIGAN 1.