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A JOAQUIN COUNTY PUBLIC HEALTH SERVICES `� <br /> ENVIRONMENTAL HEALTH DIVISION! <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILLTY SITE NAME FACILITY CONTACT NAME <br /> FCAA <br /> I FACILITY ADDRESS <br /> L SITE PHONE # with AREA CODE <br /> 1 \�\C . <br /> T CITYSTATE ZIP CODE # of TANKS <br /> Y �CIXIAI 9S�2G 6 at SITE <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P <br /> L S C G <br /> I MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> C 2 <br /> A <br /> NCITY �� STATE ZIP CODE TYPE of APPLICATION <br /> T CLOSURE, INSTALLATION, etc. <br /> A <br /> TOTAL <br /> C 1986 1987 1 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br /> Or <br /> E TANK FEE = 550.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F # Tanks = ��fee for 1986 1987 1988 1989 1994 1995 990 <br /> A (aultiply # by 1991 1992 1993 11996 <br /> [ each year applicable) —01 <br /> 5d- L)6-1 <br /> /01 S <br /> L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> I <br /> T # Tanks {_ x 556.00 1986 through 1990 1991 through 1996 <br /> Y (anter amount and year) <br /> r lC� S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Ptace) TANK I.D. #(s) <br /> C <br /> UCLOSURE FEE = $53.00 per hour (3 hours minimum per TANK) # TANK(s)_L X $159.00 C, <br /> S J <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. #(s) <br /> R <br /> E TEMPCRARY CLOSURE FEE = $150.00 each TANK # TANK(s) X 5150.00 = 5 <br /> P PLAN CHECK (Install. Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> Al <br /> N I PLAN CHECK FEE - $53.00 per hour (8 hours minimum per Facility) = 5424.00 minimum S <br /> R REPAIR FEE (workplan review & construction inspections) TANK I.D. #(s) <br /> E <br /> P TANK REPAIR FEE = 553.00 per hour (3 hours minima/TANK) # TANK(s) X $159.00 = S <br /> A <br /> 1 <br /> R PIPING REPAIR FEE = $53.00 per hour (3 hour minimum per facility = 5159.00) g <br /> N CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> S <br /> C FEE = 553.00/hr FEE = 553.00/hr FEE = 5 53.00/hr <br /> TOTAL DUE S I <br /> OFFICE USE ONLY <br /> r.xr...».r«.�e.....»n......».«»..w..,.z....»....,...».»..wwi:»...,.»...».«,....w.:........_..................................... ........................................_......_....__ <br /> '°'' t�`dJ`we`ii. <br /> a a <br /> ..as:r.me.,...arxmxn,x�r..mn„ar.ws..sa.K <...ar....w,ar.....r.......�w.,ar...,w.......x�.....x.a..............r..s.......sw: <br /> EX 23 032 (REV 1/10/911 it <br /> Pace 11 <br />