Laserfiche WebLink
SAN JOAQUIN COUNTY 10 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3d Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax(P floor):(209)468-3433 Web:www.sjgov.orgjehd <br /> FACILITY NAME FACILITY CONTACT NAME <br /> FACILITY-ADDRESS SITE PHONE#WITH AREA CODE <br /> 1 1 ®- To ® ) jT ( <br /> CITY -T STATE ZIP CODE I #OF TANKS AT SITE <br /> C G1 CA <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> S14 StC ULS ILL, fkwLa,o <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> V�o 6��L*vkv% Au-e- (40Y ) 11 403 � <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE CONTRACTOR ICC# <br /> 4 <br /> Closure In,t,iltion Re i Retrofit <br /> ACTIVE FACILITY <br /> 2000 2001 2002 2003 2004 2005 <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK <br /> $125 PER TANK AFTER FIRST TANK <br /> TANK PENALTY ASSESSED <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): CLOSURE FEE=$279/TANK [ #TANKS X$279 <br /> TEMPORARY CLOSURE <br /> (Plan Review and Inspections) <br /> TANK ID#(s): TEMPORARY CLOSURE FEE=$279 1 FACILITY <br /> INSTALLATION PLAN CHECK <br /> (Plan Check and Construction Inspections) <br /> TANK 10#(s): PLAN CHECK FEE=$744/FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <br /> TANK RETROFIT REPAIR FEE =$279/FACILITY use for monitoring equipment,spill buckets,tank sumps,misc.) <br /> PIPING REPAIR FEE $279/FACILITY use for piping,under-dispenser containment,ect.) <br /> MISCELLANEOUS <br /> TRANSFER FEE $20 <br /> CONSULTATION FEE $931 HOUR <br /> UNAUTHORIZED RELEASE EVALUATION FEE $93/HOUR <br /> SAMPLING INSPECTION FEE $93/HOUR <br /> ALL FEES ARE BASED ON THE$93 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED <br /> SR <br /> EH 23 032(REVISED 02/22/05) <br />