Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />UNDENdb1ND STORAGE TANK PROGRAM - FEE WORKSHEET dk <br />mom <br />FACILITY SITE NAME <br />FACILITY CONTAC NAME <br />F <br />A <br />9RT LfIv�PEtiGF <br />�� <br />WIler � <br />C <br />ttiLE <br />I <br />FACILITY ADDRESS <br />SITE PHONE / with AREA C� <br />4D fig(/ <br />T <br />CITY /J <br />STATE <br />ZIP CODE <br />0 of TANKS <br />Y <br />/I /SOA/ <br />�' <br />JG'r� <br />at SITE / <br />A <br />APPLICANT/SILLING NAME <br />APPLICANT CONTACT SANE <br />P <br />P <br />Se�Fole'o <br />L <br />I <br />NAILING ADDRESS � <br />`f3/ w, <br />APPLICANT PHONE f WITH AREA CODE <br />�/ cy�7o <br />209 525! �l653 <br />N <br />T <br />CITY/]/) <br />///OOESTO <br />STATE <br />Cfj- <br />ZIP CODE <br />TYPE of APPLICATION <br />CLOSURE, INSTALLATION, atC. <br />A <br />Z TOTAL <br />C <br />T <br />ANNUAL FACILITY FEE (Prior to January 1. 1941) • $100.00 <br />1966 <br />1987 <br />968 <br />1989 <br />vU <br />�(] <br />s ' <br />v <br />E <br />TANK FEE 550.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br />F <br />M Tanks <br />1988 <br />1967 <br />1988 <br />1969 <br />1990 1991 1992 <br />1993 <br />1991 <br />1995 <br />1996 �' <br />A <br />Caul tiply YY by fe• for <br />l6rj <br />JX <br />/00 <br />,lYJ i0 <br />s- <br />C <br />each year applleable) <br />I <br />L <br />I <br />STATE SURCHARGE • 556.00 each TANK (Due #very 5 years) tee California N S S Code, Sectl on 25287 <br />T <br />(enter Tter ■ 556.00 <br />1966 through 1990 1991 through 1996 <br />T <br />( #mane and year) <br />lE <br />PERMANENT CLOSURE (Removal or Authorlttd Closurt-ln-Place) TANK I.D. JIM <br />C <br />L <br />0 <br />CLOSURE FEE • $53.00 per hour (3 hours m1nlmA per TANK) <br />/TANK(#) / K $159.00 • <br />s /,r'9 �� <br />S <br />U <br />D. #(a) <br />TEMPORARY CLOSURE (A one-time pernit, for reviw/Inspections)F#TANK(s) <br />R <br />— <br />E <br />TEMPORARY CLOSURE FEE • $150.00 each TANK K $150.00 • <br />! <br />PLAN CHECK (Install. Plan Ravi em i Construction Inspections) <br />TANK 1.0. @(a)_ <br />L <br />A <br />JNP <br />PLAN CHECK FEE - 253.00 per hour (8 hours minimum per Facility) • $424.00 ■inlatae <br />s <br />14 I TRANSFER FEE • $20.00 I I UNAUTHORIZED RELEASE EVALUATION • 553.00/hr f <br />Sl <br />C I CONSULTATION FEE • $53.00/hr SAMPLING INSPECTION FEE • 553.00/hr <br />I�� TOTAL DUE <br />C.OFFICE USE ONLY � d— . <br />EN 23 032 (REV 4/8/911 ft Ppm 11 <br />0 <br />0 ./75-2 <br />