Laserfiche WebLink
r <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE YANK PROGRAM - FEE WORKSHEET <br /> FACILITY CONTACT NAME <br /> 511E NAME <br /> coni !>40una KANocj 2NNoV-Ps <br /> SITE PHONE 0 with AREA CODE <br /> ILITT ADDRESS 1100 S CNt-2f)�CE� Zpy -u-:� — lbY0 <br /> STATE <br /> �A' 21TANKS <br /> gS2�t� at SITE <br /> CIIT 0 <br /> APPLICANT CONTACT NAME .� <br /> A APPLICANT/BILLING NAME to <br /> ��K1G0 �tca/Iah L $41CEO P <br /> L APPLICANT PHONE 1 WITH AREA CODE <br /> I MAILING APORESS <br /> Cq/31PPLICATION <br /> -1c �cosuyzE <br /> N CITY STATE <br /> T T 2 �P CODE s fy05 ,A INSTALLATION, etc. <br /> aoQES-(v <br /> TOTAL <br /> A 1986 1987 1988 1989 1990 <br /> C1991) $100.00 <br /> I ANNUAL FACILITY FEE (Prior to January 1, S <br /> v $170/TANK (ef ter January 1, 1991) <br /> E TANK FEE • $50.00/TANK (prior to January 1,1991) <br /> F s Tanks - 1986 1987 1988 1989 1990 1991 1992 1995 1994 1995 1996 <br /> A (multiply %by Fee for f <br /> C each year appticabte) <br /> I <br /> L STATE SURCHARGE • $56.00 each TANK l0ua every S years) See California N 6 S Code, Section 2528 <br /> I <br /> 1 s IaNts x (56.00 1986 through 1990 1991 through 1996 <br /> t (enteramolnt and Year) f <br /> PERMANENT CLOSURE (Remayst or Authorized Ctosure-In-Ptace) TANK I.O. i(q <br /> L CLOSURE TEE • $53.00 per hour (3 hours minimum per TANK) / TANK(a) I _ % 1159.00 • f 5 4•O O <br /> O <br /> S <br /> U TEMPORARY CLOSURE (A oro-time permit, for review/inspeetlore) TANK I.D. I►(a) <br /> E IEMPCRART CLOSURE FEE • !150.00 each TANKlarmaiallala <br /> �"- <br /> 222 <br /> P PLAN CHECK (Inst.I SMC <br /> A TERRY HAM ETON,RESIDENt 39/ 90-3732/1211 <br /> N PUN CHECK FEE - RICHARO C. HAMILTON. V4M -�•- 19---- <br /> 431 ATCH AD. 20"24- <br /> MODESTO, CA 95951 <br /> $ /SJ- ° ° <br /> R REPAIR FEE (workp PAY TO THE . � '� �• <br /> E T ORDER OF t)OLLARS <br /> P TANK REPAIR FEE • — <br /> A <br /> I <br /> R PIPING REPAIR FEEr,S•r� M.HEHAY OFFICE <br /> MODE �x P O.BOX 62n <br /> ���Ne Kw 11^iV CALIFORit; NAe636�1 <br /> ODCSTO, <br /> N TRANSFER FEE • • / L Iwo, 4 — <br /> S <br /> 1 <br /> C CONSULTATION PEE • MEMO ' • • • <br /> T• , t - IuTAL DUE f <br /> OFFICE USE ONLY <br /> .V,���1•�M�•�1 M w•M M w•M,IM IM,I Y�w M w M.,M 1M•r wM YM,w M Y M�M r M�,�M M a�M�1•M M 1M M r M r M r•��,��Ia <br /> °"'sisidsf"►•" dd17T€i�Y H)T" NI'4fi'•L�€" '" d11N'9CcEli .e <br /> �" € °T/LFA3II" IFE'c�IV€U°I>� ""• "1fXTE"IIEC'IV€V"'r <br /> •.�m.�...s.erwxwrrwrrsrArrral�i rMrwsrrsriorArrmrrrAasrrrrxrrrrimrmrwrrwr.wrs+m.. <br /> EN 23 032 (REV 4/8/911 It peas 11 <br />