Laserfiche WebLink
SAN JOAOUIN CC PUBLIC HEALTH SERVICES - ENVIRONMENTAL HF H DIVISION <br /> UNDER OUND STORAGE TANK PROGRAM - FEE UORKSHEET <br /> S FACILITY SITE NAME `��i FACILITY CONTACT NAME <br /> T, ire-iie rwil it " J!/1G0�,, <br /> E FACILITY ADDRESS 1 SITE PHONE # with AREA CODE <br /> L I(v47o ' �7r1/7G(; L7(- <br /> CITY STATE ZIP CODE # of TANKS <br /> AL'fh17 1 <br /> at SITE 2 <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> I �Hia Dei' laI vu Inc: rcl. <br /> C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> N <br /> T CITY STATE ZIP CODE TYPE of APELICATIngll <br /> +tion c (Closure, Installation etc.) <br /> TOTAL <br /> 7986 7987 1988 1989 1990 1$..rJ� <br /> aaaw <br /> ANNUAL FACILITY FEE (Prior to January 1, 1997) = SSD9:U0 �- <br /> A i ``>r xxxx I xxxx xxxx XXX% xxxx 5 xxxXxxxxxXxxx <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX xxxx xxxx XXXx xxxx S xxxxx%xxxxXxx <br /> opruv atmW <br /> Y TANK FEE = S8II;96/TANK (Prior to January 1,1997) 5170/TANK (After January 1, 1991) <br /> E DiD N/�t1 <br /> # Tanks = 1986 1987 1988 1989 7990 1991 1992 17993 1994 1995 7996 X40 (D �K <br /> Eeachyear <br /> # by fee for <br /> r applicable) xxxx xxxx xxxX xXXX xxxx SC 4— <br /> LTY FEES ASSESSED %X%% %%XX %x%X %%XX %X%X - S CHARGE - 556.00 each TANK (Due every 5 years) See California H L S Code, Section 25287 <br /> x 556.00 1988 through 1990 1991 through 1996 <br /> ount and year) <br /> S <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> L <br /> 0 CLOSURE FEE = 578.00/hour (3 hours minim WTANK) # TANK(s)_ X 5234.00 = S <br /> S <br /> U TEMPORARY CLOSURE (Plan Review L Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE - 578.00/hour (3 hours mininAVFACILITY) 5234.00 minimm S <br /> P INSTALLATION PLAN CHECK (Plan Review L Construction Inspections) TANK I.D. #(s) 301 ZOe> -01 All O Z- <br /> L X00 <br /> A 12•d� I�lLyw <br /> N PLAN CHECK FEE = 578.00/hour (8 hours mininun/FACILITY) = $624.00 minimrn 5 24 <br /> .so <br /> R REPAIR FEE (Workplan Review L Construction Inspections) TANK I.D. #(s) <br /> - <br /> E <br /> P TANK LINING REPAIR FEE - 578.001hour (3 hours minimlm/TANK) # TANK(s) X 5234.00 S <br /> A <br /> I TANK RETROFIT REPAIR FEE - 578.00/hour (3 hours min./FACILITY) = 5234.00 minimm S <br /> R <br /> PIPING REPAIR FEE = 578.00/hour (3 hours minim=/FACILITY) = $234.00 mini=m S <br /> M TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION = 578.00/hr S <br /> 1 <br /> S <br /> C CONSULTATION FEE • 578.00/hr SAMPLING INSPECTION .FEE • 578.00/hr <br /> TOTAL DUE S <br /> FOR OFFICE USE ONLY a <br /> ® SWEEPS # COMPUTER # LOC COOS DIST CODE AMOUNT RECEIVED CHECK #/CASH RECEIVED BY DATE RECEIVED <br /> a s _ <br /> S <br /> 9 <br />