Laserfiche WebLink
`/ �-l' <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> C <br /> Pte. o��dr2 co r / <br /> 1 FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> L <br /> 1 <br /> T CITY STATE ZIP CODE # of TANKS <br /> Y S"� at SITE <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P <br /> L <br /> 1 MAILING ADDRESS APPLICANT PHONE # WITHAREA CODE <br /> C <br /> A <br /> N CITY STATE ZIP CODE TYPE of APPLICATION <br /> T CLOSURE, INSTALLATION, etc. <br /> TOTAL <br /> A <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br /> I /!PO /00 /00 /Ov /OD E �D <br /> V <br /> E TANK FEE = $50.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F # Tanks = 2 5 Y� 4 86 °7 88 989 ?1990 1991 1992 1993 1994 1995 1996 <br /> A (mil t iply # by tee for <br /> C each year applicable) Zoo ZOO 2OU /OD <br /> 1 <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 /> moun <br /> Y (enter at and year) <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> C <br /> L CLOSURE FEE = $53.00 per hour (3 hours minimum per TANK) # TANK(s)_ X 5159.00 = $ 5 O <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review 8 inspections TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = 5150.00 each TANK # TANK(s) _ X $150.00 = S <br /> poiL 1170q <br /> P PLAN CHECK (Install. Plan Review & Construction Inspections) TANK I.D. #(s) PR 17 O <br /> ct jL <br /> A <br /> N PLAN CHECK FEE - 553.00 per hour (8 hours minimum per Facility) = $424.00 mini mm $ <br /> R REPAIR TANK I.D. #(s) <br /> - <br /> E <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimum/TANK) # TANK(s) X $159.00 = E <br /> A <br /> 1 <br /> R PIPING REPAIR REVIEW & CONSTRUCTION = $53.00 per hour (3 hour minimum per facility = $159.00) $ <br /> M CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> S <br /> C I FEE = 553.00/hr FEE = 553.00/hr FEE = 5 53.00/hr <br /> TOTAL DUE S <br /> OFFICE USE ONLY <br /> ............................................................. . .. ............................o......................... ................... <br /> . ..................................................................................... <br /> ss»»sx»z»»w»raw»a»z»xx»zwxaeex6z«:.iueima»x<exaexwe:rnxavxmxxe:w::u+n«er.:bwcsx;:-:.�z>:o>.:.;.',"::'::.u:aaw:ae:eemxwxemeweewwwmmeerww.wz.wxamxe.wxasxwesxwum <br /> �c 0 COU$ STC e- ' .wol1N7"RCVIS', CNECIC��/�CAS11� IiCW�9 �it �ff '� t ff-r mst <br /> g <br /> i » <br /> » I 5»i S <br /> •»»»xwexaa»v»»w,sxw=»x«s z»»we»»xaaexw'wwxea.roe •••.•••... .. ........ .....•..... ........•.• .••••••• •••••••• <br /> ron:ar»vavwnxwranxm.:.:n::.. ............... .........................5 <br /> exnxaw<eexa6e iwsfeaweo»wo»veenne,s'»r.x»xwsxw <br /> MY��DYIIiARII'iOYRR��OMAA%hH�`9+fSAYR293 AY6�:LYSL%i5Y?XGS:AY'�:{�wY::y:3:."Y.AK.^.um':.`:^:::x:::.:>•:;nn2::A::S:`LYi:S:.S.W.�'1%LSY YF".Yi��laW�Y%81YAMfAI%PYi�Y0Y6AYVfMYip�A�lYfa'6O <br /> . a mn .nom.. 'n,ac inns s. Dem tt <br />