Laserfiche WebLink
SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES s •- <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (WERGROIND STORAGE TANK PROGRAM FEE UORKSMEET <br /> III tit! NAME FACILITY CONTACT NAM! <br /> ion Brace Evelyn Tatum <br /> FACILITT ADDRESS Slt! PHONE R with AREA CODE 527 N. Filbert St N/A <br /> I CITY STATE 210 CODE / of IAMK! <br /> ( Stockton, Ca. at 1ti! 1 <br /> A APPUCANI/81LLING NAME APPLICANT CONTACT NAME <br /> p Jim Drace Evelyn Tatum <br /> 1 NAILING ADDRESS 995 Benjamin holt Dr. APPLICANT PHONE / ITT IN AREA CODE <br /> C — <br /> A <br /> M :IIT <br /> STATE TIP [DIE TYPE of APPLiG110M <br /> ( Stockton, Ca. 95207 CLOSURE, INSTAIIATIdI, ate. Removal <br /> TOTAL, <br /> A <br /> C 1986 1987 1988 1989 1990 1991 <br /> I ANNUAL FACILITY FEE (Prior to January 1, 1991) • 6100.00 <br /> 1 X X X 5 00 <br /> V <br /> E TANK IEE + 150.00/TANK (prler to January 1,1991) 1110/1ANK (alter January 1, 1991) <br /> r R Tank* 1 19 <br /> applicable) 86 1987 1988 1989 1990 1991 1992 1997 1094 1995 1996 <br /> A (mdtlply 1f�y-fee Tor <br /> c each year plicable) x x X x x X 5420.00 <br /> 1 <br /> L STATE SURCHARGE 156.00 each TANK (Doe every S year!) Sea California N 1 ! Code, Section 25287 <br /> t R Tanks 1 R 156.00 1986 threu9h 1990 1091 through 1096 <br /> Y (enter snant and year) 5 102.00 �1 a <br /> X X <br /> PERMANENT CLOSURE (Removal or Authorized Closure-In-Place) <br /> C <br /> t Ctomme FEE • 153.00 per hour (3 hours min ImUM per TANK) 1 TANk(a)�_ X !159.00 5 159.00 <br /> 0 <br /> s <br /> U TEMPORARY C105IME (A one-time permit, for revleu/Inspections) TANK I.D. R(a) - <br /> R 1 <br /> E TEMPORARY CLOSURE FEE • 1150.00 each TANK N tANK(s) — K 11150.00 <br /> P PLAN CHECK (I,mtotl. Plan Revleu C Construction Inspections) TANK I.D. R(f) ' <br /> t <br /> A a 1424.00 minlnt" 5 <br /> N PIAN CREEK FEE - 157.00 per hour (8 hours minlinsn per ieelllty) <br /> R REPAIR IEE (workplan review S construction Inspections) TANK 1.0. R(s) <br /> E1 <br /> r TANK REPAIR FEE + 153.00 per hour U hours minlmun/TANK) R TANK(a) k 1159.00 <br /> A <br /> I 1 <br /> a PIPING REPAIR FEE 1151.00 per hour (3 hour minimum per facility + 1159.00) <br /> N CONSULTATIONS UNAUTHOR12ED RELEASE EVALUAIION SAMPLING INSPECTION <br /> 1 . <br /> S <br /> c FEE IEE + 153.00/hr FEE a 1 55.00/hr <br /> TOTAL DUE 11 ,281 .00 <br /> OFFICE USE ONLY <br /> rIffirmTTer, ------- <br /> T o ._ - T � <br /> ra7GTA—a�iiTi " CiA7iaT' AZGr"wTw'rawx,+r•a I <br /> ww "•i e.x.•SY w7AtT•+wA'Sa.a7 <br /> wwwaMM•MMaMMMRMMaMMM MAMMMM•MmM Mm1MMMMMMMMMa1�MMNMMMMMmMMMNMMAl111MMMMmMMMMMM ,xM <br /> fm 23 032 (REV 1/t0/911 it Pfot 1 1 �J <br /> V I � <br /> ( <br />