Laserfiche WebLink
SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> FACILITY NAME FACILITY CONTACT NAME <br /> frac to me,191JAk <br /> FACILITVADDRESS SITE P14ONE#WITH AREA CODE <br /> CITY STATE ZIP CODE III <br /> OF TANKS AT 817E <br /> CA 15376 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> U art c I 09 8 - s/ <br /> I STATE ZIP CODE / CIRCLE WORK TO BE DONE: <br /> Lr 3 /�7 60 Ctaeu Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> 1998 1999 2000 2001 2002 2003 <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK 0170lXpaxol l$T>%XMwft) <br /> $125 PER TANK AFTER FIRST TANK $ <br /> TANK PENALTY ASSES3m <br /> TANK SURCHARGE_$151 TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY IXJ INVENTORY IN A COPA PROGRAM=824.00/FACILITY <br /> PERMANENT CLOSURE <br /> Removal a Permitted Closure In Place <br /> TANK ID#(s): CLOSURE FEE=$2791 TANK #TANKS X 8279= $1> <br /> TEMPORARY CLOSURE <br /> Ian Review and I ns <br /> TANK IO#(a): TEMPORARY CLOSURE FEE=$279/FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Ian Check and Construction Inspections) <br /> TANK ID#(a): PLAN CHECK FEE=$744/FACILITY ${ <br /> REPAIR PLAN CHECK <br /> TANK ID#(a): <br /> $ <br /> TANK RETROFIT REPAIR FEE _$2791 FACILITY use far monrodag equlpunK spill buckets,tank surrips,misc. <br /> $ <br /> PIPING REPAIR FEE =$279 I FACILITY use for piping,under-dl max mntainmerd,art. <br /> MISCELLANEOUS <br /> $ <br /> TRANSFER FEE _ $20 <br /> S <br /> CONSULTATION FEE _ $931 HOUR <br /> $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = S 931 HOUR <br /> $ <br /> SAMPLING INSPECTION FEE = S 931 HOUR <br /> ALL FEES ARE BASED ON THE$W HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# I AMOUNT RECEIVED CHECK# RECEIVED BY I DATE RECEIVED <br /> SR <br /> EH 23 032(REVISED 11/24/031 <br />