Laserfiche WebLink
U <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> EyplRp(•1Iy0TAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM -FEE WORKSHEET <br /> S FACILITY SITE NAME `\ FACILITY CONTACT NAME <br /> T SITE PHONE I with AREA CODE <br /> E FACILITY ADDRESS <br /> &— STATEI ZIP CODE 3 of TANKS <br /> CITY15 at SITE <br /> A p <br /> P APPLICANT CONTACT NAME <br /> P APPLICANT/BILLING NAME <br /> L <br /> I APPLICANT PHONE X WITH AREA CODE <br /> A MAILING ADDRESS <br /> �. mrv.D�We.e Qv.. 1'-1 2b-b 5 <br /> T CITY STATE ZIP CCOE I TYPE of APPLICATION. <br /> J Q <br /> L1>\ I D Z (Closure, Installati an, etc.) 0)v0-`• <br /> TOTAL <br /> AI TANK FEE = S50.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> T X Tanks = P19116TW19117j19M 1989 11990 1991 1992 11993 11994 11995 1996 <br /> I (multiply boy,fee forv each year applicable) )C(XXXXXXTANK PENALTY FEES ASSESSED XXXX I %XXX XXXX I I S <br /> S <br /> I STATE SURCHARGE = 556.00 each TANK (Due every 5 years) See California H b S Cade, Section 2528 <br /> T1991 through 1996 <br /> E X Tanks_ x $56.00 1986 through 1990 <br /> (Enter amount and year) 5 <br /> C PERMANE4T CLOSURE CRemcval or Authorized Closure-in-Place) TANK I.D. *(a) <br /> 0 CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) <br /> S TANK(S) - % 5234.00 5 <br /> STANK I.D. 4(s) <br /> U TEMPORARY CLOSURE (Plan Review b Inspections) <br /> ER S <br /> 1 TEMPORARY CLOSURE FEE = 578.00/hour (3 hours mi nimua/FACILITY) � 5234.00 minimum <br /> P INSTALLATION PIAN CHECK (Plan Review & Construction Inspections) TANK I.D. S(S) <br /> L <br /> A - S624.00 minimum 3 <br /> N PLAN CHECK FEE - S78.00/hour (8 hours minimum/FACILITY) <br /> R REPAIR FEE (Workplan Review 3 Construction Inspections) TANK I.D. X(s) <br /> Es <br /> P TANK LINING REPAIR FEE = 578.00/hour (3 hours ainimm/TANK) X TANK(s) X 5234.00 <br /> AS <br /> I TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) 3234.00 minimum <br /> R <br /> PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) 5234.00 minimum S <br /> M TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION = $78.00/hr IEIS <br /> 3 <br /> C CONSULTATION FEE S78.00/hr SAMPLING INSPECTION FEE = 578.00/hr <br /> ov <br /> EEE <br /> TOTAL DUE <br /> ]—m Off1C.E_VSE_c".—..._ _--_—__— <br /> �S'WEeS 3 CCMPUTECR LOC CODE �OT51'-CdOE AMWN1�i2Cc VED CHEC�%G1SH xEE'_-TyED 3Y �OAfc 2c�C'cSVED :_ <br /> EH 23 046 (Revised 7/10/961 Page 11 <br />