Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVSION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> SF ITT SITE NAM! ' <br /> I FACILITY CONTACT NAME <br /> Tj <br /> E FACIS,JTT ADDRESS SiTF C! I 4th AREA CODE <br /> e� <br /> J 5 1UV E� <br /> 4 <br /> CITY �- ��/ , STj� lip CODE ! o TANKS <br /> P <br /> A ('' at SITE / <br /> P APPIIGVIi/tiILIMG MAFE/ APPL CANT CON)ACT MAW <br /> C NAILING ADDRESS APPLICANT PHONE R WITH AREA CODE <br /> M <br /> T CIT! =a TYPE of APPLICATION <br /> 41/10 a [`� insure, Installation, eta.) <br /> TOTAL <br /> ANNUAL FACILITY FEE (Prior to Jartwry-il-d9gT9-. $1400-001986 1987 1986 1989 1990 <br /> A <br /> C j <br /> T FACILITY PENALTY FEES ASSESSED (If Applkeble) 7000( XXXX � <br /> I <br /> V TANK FEE • S50.00/TAHK (Prior to Jervery 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> A Tanks a 1986 1967 1988 1989 1 1990 1991 1992 1993 1990 1995 1996 <br /> F (mo(t 1pty f by fee for <br /> A each year applicable) t <br /> C -/Ci 1 / (-' <br /> I TANK PENALTY FEES ASSESSED 10(X7( 7000 ��- S <br /> L <br /> I STATE SURCHARGE • 256.00 each TANK (Due every 5 years) Sea Callfornls H i S Code, Section 25287 <br /> 7 <br /> T e Tanks A $56.00 1966 through 1990 1991 through 1996 <br /> (Enter m t and year) <br /> s <br /> C PERMANENT CLOSURE (Removal or Authorized Cloture-in-Place) TANK I.D. f(s) <br /> L <br /> O CLOSURE FEE • S78.00/hour (3 hart minimun/TANK) R TANK(s) X 1234.00 . It <br /> 5 <br /> U TEMPORARY CLOSURE (Plan Review 6 Inspectionm)• TANK I.D. t(a) <br /> R <br /> E TEMPORARY CLOSURE FEE • S78.00/hour (3 hours mininWFACILITY) o 2234.00 Mint" S <br /> PINSTALLATION PLAN CHECK (Plan Review L Cortstruetlon Inspectlons) TANK I.D. t(a) <br /> L <br /> A <br /> N PLAN CHECK FEE • 278.00/how (8 hours minimWFACILITY) • 2624.00 mint" t <br /> R REPAIR FEE (Workplan Review 2 Construction Intpeetioru) TANK I.D. t(a) <br /> E <br /> P TANK LINING REPAIR FEE • S78.00/hour (3 hours minieuVTARK) STANK(*) _ X 2234.00 • S <br /> A <br /> I TANK RETROFIT REPAIR FEE • 278.00/hour (3 hours min./FACILITY) • 2234.00 minimum i <br /> R <br /> PIPING REPAIR FEE a S78.00/how (3 hours mininae/FACILITY) • 2234.00 minimus 2 <br /> M TRANSFER FEE a 220,00 UTAUTNCRIZED RELEASE EVALUATION • 278.00/hr s <br /> I <br /> S <br /> C CONSULTATION FEE • 278.00/hr SAMPLING INSPECTION FEE • 278.00/hr S <br /> TOTAL DUEt <br /> FOR OFFICE USE ONLY <br /> —_ CCS•Ta?�RiwwCC=s•a............��'��...... _.__.._ <br /> V" S4€ti7'!'I'=== 7 'Uf'!T" A�d11N'f! '79811`^ 41��1@A111" 'TCE3"J4"'^"1f�TL'�IEZF�1Eff�•'w <br /> a U1 t a <br /> OI1�aa>•>•Iml>••�a%aremalaam/Aamlr!/ '��MIamMMMraa111Olimmi>•ml�•I/>falmll a1ll�mafY1•amwOlRM�twr�l•fam>tl/ <br /> EH 23 032 (REVISED 3-1-931 Pane 11 -- <br />