Laserfiche WebLink
SAN JL.IUIN LOCAL HEALTH DIST�CT .. 1 <br /> UNDERGROUND STORAGE TANK PROGRAM FEE NORKSHEET S <br /> I FACILITY/SITE NAME - - FACILITY CONTACT NAME (� <br /> A <br /> C <br /> 1 —� SITE PHONE 111 TM "waw coda <br /> L STREET ADDRESS <br /> 1 v S(xD � ,.� !may-._.111_s-- .-..- <br /> Y CITY STATE 11P CODE 1 of Tanks <br /> 1 iE -�it Site - <br /> A APPLICANT/BILLING NAME J- APPLICANT CONTACT NAME <br /> P <br /> F _ <br /> L ------ ------- -- APPLICANT PHONE 1 WITH "[aa cava <br /> I MAILING ADDRESS <br /> N CITY - STAT IIP CODE TYPE of APPLICATION <br /> tlotulla. INSTALLATION. [rc. <br /> FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR TOTAL <br /> A ------ ---.....-.-_ - 9 ---- <br /> —d <br /> T - 9B6 �- 1987 —1988- 98 - <br /> I 1 <br /> V - -- <br /> E TANK FEE = 150.00 each TANK <br /> I 1 Tanks_ _ x (50.00 1986 19E 1988 1989 <br /> A (multiply 16y fee for '— � <br /> C each year applIcafee r - <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH 6 SAFETY CODE Sec 25281 for applicability) <br /> 1 1 Tanks__ x 156.00 1986 1981 1988 1983 <br /> Y (enter amofint and year) -- f <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> O CLOSURE FEE = 190.00 each TANK I Tanks_ _- x 190.00 <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) - <br /> TEMPORARY CLOSURE FEE = 180.00 each TANK I Tanks x 180.00 f <br /> P PLAN CHECK (Installation or Repair) — <br /> L ----- --------------- ------- -- <br /> A 1 <br /> 11 PLAN CHECK FEE = 130.00 each SUBMISSION/RESUBMISSION <br /> REPAIR <br /> R TANK REPAIR FEE = 1110.00 each TANK 1 Tanks x 1110.00 f <br /> F ---- ---- ------- ----- <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (when applicable) (when applicable) (when applicable) — <br /> FEE = f30.00/hrf FEE = 135.00/hrL FEE - $35_00/hr f <br /> -- TOTAL DUE f <br /> OFFICE USE ONLY <br /> SNEEPS 1 COMP 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK 1/CASH RCVD BY DATE RECEIVED PERMIT <br /> --.... <br />