COMPLIANCE INFO_2003-2011 - Laserfiche WebLink

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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 Telephone: (209) 468-3420 Fax (5hfloor): (209) 468-3433 Web: www.sigov.org/ehd FACILITY NAME FACILITY CONTACT NAME sk-ry L 2000 FACILITY ADDRESS SITE PHONE # WITH AREA CODE 1 �o - U CITY STATE I ZIP CODE # OF TANKS AT SITE CONTRACTOR ICC # CA 12004 i/ APPLICANT BILLING NAME APPLICANT CONTACT NAME sk-ry L 2000 APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE i) t a - CITY I STATE I ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC # CS 12004 i/ Closure Installation a ai etrofit $125 PER TANK AFTER FIRST TANK ACTIVE FACILITY TANK ID # (s): CLOSURE FEE = $279 / TANK 2000 2001 2002 2003 2005 $500 FEE INCLUDES FACILITY FEE + 1 TANK UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR 12004 SAMPLING INSPECTION FEE _ $ 93/ HOUR $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 = $279 / TANK # TANKS X $279 TEMPORARY CLOSURE Plan Review and Inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $279 / FACILITY kL-LATION PLAN CHECK Check and Construction Ir PLAN CHECK FEE = $744 / FACI REPAIR PLAN CHECK TANK ID # s TANK RETROFIT REPAIR FEE = $279 / FACILITY use for monitoring equipment, spill buckets, tank sumps, misc. TRANSFER FEE _ $ 20 PIPING REPAIR FEE = $279 / FACILITY use for piping, under -dispenser containment, ect. MISCELLANEOUS TRANSFER FEE _ $ 20 CONSULTATION FEE _ $ 93/ HOUR UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR SAMPLING INSPECTION FEE _ $ 93/ HOUR ALL FEES ARE BASED ON THE $93 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TU APPLICANT. OFFICE USE ONLY, SERVICE REQUEST # FACILITY 1D AMOUNT RECEIVED CHECK # RECEIVED BY I DATE RECEIVED SR EH 23 032 (REVISED 02122/05)