Laserfiche WebLink
/ SAN JOAOUI■ COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVSION <br /> IOm ROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> Aw S FACILITY SITE NAME FACILITY CONTACT NAME <br /> I <br /> E FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> c 2 ue Slo - z - 560 <br /> CITY STATE ZIP CODE # of TANKS <br /> AC L. �'�, at SITE 2, <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> A L "2 - 165-l6bo <br /> N <br /> T CITY STATEI ZIP CODE(. TYPE APPLICATION <br /> �L�JF C osure, Installation, etc.) <br /> TOTAL <br /> ANNUAL FACILITY FEE (Prier to January 1, 1991) a 5100.00 1986 1987 1988 1989 1990 <br /> A KM XXxx %X%X XXXX S <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) I Xxxx XXXX I %XXX I XXX% S <br /> I <br /> V TANK FEE = 550.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> 0 Tanks = 1986 11987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F (multiply ##by fee for <br /> A each year applicable) )000( I xxxx XXxX XX%X S <br /> C <br /> I TANK PENALTY FEES ASSESSED I XXXX I xx%X XX%X %XXX I I f <br /> L <br /> 1 STATE SURCHARGE = 256.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> T <br /> T # Tanks x 556.00 1988 through 1990 1991 through 1996 <br /> (Enter amount and year) <br /> S <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> L <br /> 0 CLOSURE FEE - S78.00/hour (3 hours minimum/TANK) # TANK(s) 2. X 5234.00 = S <br /> S <br /> U TEMPORARY CLOSURE (Plan Review S Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimm/FACILITY) $234.00 minimmm f <br /> P INSTALLATION PLAN CHECK (Plan Review 6 Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = 578.00/hour (8 hours minimm/FACILITY) = S624.00 minimum S <br /> R REPAIR FEE (Workplan Review i Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE - 578.00/hour (3 hours minimum/TANK) # TANK(s) X 5234.00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE - S78.00/hour (3 hours min./FACILITY) = $234.00 minimum S <br /> R <br /> PIPING REPAIR FEE = f78.00/hour (3 hours minimm/FACILITY) = S234.00 minimum S <br /> M TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION - S78.00/hr S <br /> I <br /> 5 <br /> C CONSULTATION FEE = 578.00/hr SAMPLING INSPECTION FEE - 578.00/hr S <br /> TOTAL DUE s yG <br /> FOR OFFICE USE ONLY <br /> SWEEPS # COMPUTER # LOC CODE DISI CODE AMOUNT RECEIVED CHECK #/CASH RECEIVED BY DATE RECEIVED a <br /> S a <br /> EH 23 032 (REVISED 4-6-95) <br />