Laserfiche WebLink
N JOACU19 COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UND OUND STORAGE TANK PROGRAM - FEE WORKSHEET is <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> CtC!LITY ADDRESS SITE P"t IF with AREA Me <br /> ,I <br /> T CITY / ��/� STATE ZIP CODE # of TANKS <br /> Y ` Er�.+-' at SITE <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> C <br /> A <br /> N CITY STATE ZiP CODE TYPE of APPLICATION <br /> T CLOSURE, INSTALLATION, etc. <br /> A TOTAL <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) 5100.00 <br /> I S <br /> V <br /> E TANK FEE = 550.00/TANK (prior to January 1,1991) 5170/TANK (after January 11 1991) <br /> F # Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 'YI <br /> A (multiply # by fee for <br /> each year applicable) SAO S.5-1 e) a� <br /> L STATE SURCHARGE - 256.00 each TANK (Due every 5 years) See California H 6 S Code, Section 25287 <br /> 1 <br /> T # Tanks 5 x 556.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) <br /> A91 E <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.O. #(s) H <br /> C <br /> L CLOSURE FEE = S53.00 per hour (3 hours minima per TANK) # TANK(s) X $159.00 = E 7 <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK 1.0. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = 5150.00 each TANK # TANK(s) X 5150.00 E <br /> P PLAN CHECK (Install. Plan Review b Construction Inspections) TANK I.D. #(s) <br /> - <br /> L <br /> AlN PLAN CHECK FEE - S53.00 per hour (8 hours minim per Facility) = S424.00 minion E <br /> R REPAIR FEE (workplan review 8 construction inspections) TANK I.D. #(s) <br /> E <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimuNTANK) # TANK(s) X 5159.00 = E <br /> A <br /> 1 <br /> R PIPING REPAIR FEE = $53.00 per hour (3 hour minimum per facility = S159.00) S <br /> N CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> S <br /> C FEE = 553.00/hr FEE = 553.00/hr FEE = E 53.00/hr <br /> TOTAL DUE E <br /> OFFICE USE ONLY <br /> ...........c......................._...................-.................................... ....._............................................................_......................................................................................... <br /> ar aar va iw.aw a»aao rw reu u»zeoe..a»o.aw•,.:w,..x.w..»»»oaa.=s vw...e..,......er...r w.e..e,e..e..eee. <br /> a <br /> �..y16.?7.;;�.... ..P��K..... .....����...... ....��..... E �/ 7 177158 .. . �................. .. ......... . . s <br /> w aa,o ar wxaxxrsza�,ozsrax.xwwssmxtsawxxwAxryYeoruax:wrxes:.es..aw.wamat.mo=w+�=aass:ss xaasmr�xxpmams,an .r,m.nrawsxar.r..asarr. <br /> EH 23 032 (REV 1/10/911 ft Pace 11 <br />