Laserfiche WebLink
N*.,6AN JOAOUIR COUNTY PUBLIC HEALTH SERVICES \.V <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> 5: P«tea r� Cti �E <u�a <br /> 1 FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> /4-Z;25 .1/, <br /> T CITY ^ _ _� y STATE ZIP CODE # of TANKS / <br /> Y �^�� at SITE <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> p 6Z <br /> L 41;27 <br /> I MAILING ADDRESS APPLICANT PHONE # WITH—AREA CODE�O� <br /> C `3EL/GIO 9 <br /> A <br /> N CITY / STATE 21 CDEPPL ICAT ION <br /> T 6 Q©/ LOSURE INSTALLATION, etc. <br /> A TOTAL <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = S100.00 <br /> I S <br /> V <br /> E TANK FEE = S50.00/TANK (prior to January 1,1991) $170/TANK (after January 1, 1991) <br /> F 0 Tanks 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply f1 by fee for <br /> C each year applicable) E <br /> I <br /> L STATE SURCHARGE = S56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> 1 <br /> T # Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> Y (enter amo(nt and year) <br /> S <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 $159.00 = E <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE _ $150.00 each TANK # TANK($) X $150.00 E <br /> P PLAN CHECK (Install. Plan Review 8 Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - S53.00 per hour (8 hours minimum per Facility) = $424.00 minimum 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 minimum/TANK) # TANK(s) X $159.00 E <br /> A <br /> I <br /> R PIPING REPAIR FEE _ $53.00 per hour (3 hour minimum per facilit <br /> y = $159.00) $ <br /> M TRANSFER FEE _ $20.00 UNAUTHORIZED RELEASE EVALUATION = $53.00/hr E <br /> I <br /> S <br /> C CONSULTATION FEE _ $53.00/hr SAMPLING INSPECTION FEE = $53.00/hr S <br /> TOTAL DUE E <br /> OFFICE USE ONLY <br /> . ................ . ................................................e..e..w "�ee..ne.�aeee.e. .. ...................... . <br /> w.rmww»»wxe waw«'e::six'snamsr»xeiees»wers»zarxenwe ww zes»oeesxesxr"""""""Iee>••••••"""""""u:asz»zee rw'eieee mweww.awa..ie::aew:zeeiiwe»ei aw::i:.:eez»iw iaeiisziisii <br /> a <br /> :.......................... ........................ .................... ........................ s...l..,?�y.°°...._og�.?. 7 ................. <br /> .�.......... ..� a..� ..� . _.� .� ...� a ., a .. " a� a a� � :'� <br /> mumx�ax ..xm¢mr�smscarxsAerazazmzmamceamezArazaxamzarrmamemmaz9xazaxaszm�attxranaaaxiaacr.�rzxaaamarsmxaraxr.�mzazairxam�sc�mmxxroc�mma mxxarx�axwxcx <br /> EN 23 032 (REV 4/8/911 ft Pace 11 <br />