Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVSICN <br /> U GRC(IMO STORAGE TANK PROGRAM - FEE WORKSHEE- <br /> SI FA ILITY SITE NAME FACILITY CONTACT NAME <br /> TI t N �TlaoNN Filku oT® <br /> E FAC LITY ADDRESS SITE PHONE N with AREA CODE <br /> 41 a 9 Al <br /> CITY SLATE ZIP CODE 0 of TANKS <br /> A <br /> P Q <br /> at SITE <br /> P APPIIG LLT NAME <br /> L APPLICANT CONTACT NAME <br /> Rev <br /> I <br /> C MAILING ADORES APPLICANT PHONE K WITH AREA CODE <br /> A t Oki k- <br /> [111�) <br /> N <br /> T CITY STATEI ZIP CODE I TY P of APPLICATION <br /> Installacion, etc.) <br /> TOTAL <br /> 1986 1987 11988 11989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) m 5100.00 <br /> A I XXXX XXXX f <br /> C <br /> TI FACILITY PENALTY FEES ASSESSED (If Applicable) I XXXX I XXXX I s <br /> I <br /> Y TANK FEE = 550.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> FI ITankplY SS Sy fee far 11986 1987 11988 11989 11990 1991 1992 1993 1994 1995 11996 <br /> Al each year applicable) XXX% %XXX ( I I I I s <br /> f TANK PENALTY FEES ASSESSEDI XXX% %XXX I I S <br /> Li <br /> 11 STATE SURCHARGE = 556.00 each TANK (Due every 5 years) See California 4 3 S Cade, Section 25287 <br /> T' <br /> T 3 Tanks x 556.001988 through 1990 ;991 through 1996 <br /> (Enter amowc and year) <br />�1 s <br /> li PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. Y(s) WAV <br /> S! CLOSURE FEE 278.00/hour (3 hours minimsn/TANK) t TANK(s) X 5234.00 = s =NV <br /> U1TEMPORARY CLOSURE (Plan Reviem 3 Inspections) TANK I.D. $(a) <br /> R <br /> Ej TEMPORARY CLOSURE FEE = 278.00/hour (3 hours minimuu/FACILITY) 5234.00 minimum s <br /> lIINSTALLATION PLAN CHECK (Plan RevieM 3 Construction Inspections)I TANK I.D. i(s) <br /> AlN ?LAN CHECK FEE = 578.30/hour (8 hours minimum/FACILITY) = 5624.00 minirm s <br /> RI REPAIR FEE ('Workplan RevieM 3 Construction Inspections) TANK I.D. #(s) <br /> E, <br /> Pf TANK LINING REPAIR FEE = 378.00/hour (3 hours minlmm/TANK) N TANK(s) X 5234.00 = S <br /> A <br /> I TANK :RETROFIT REPAIR FEE = 178.00/hour (3 hours min./FACILITY) = 5234.00 minimum s <br /> R <br /> PIPING REPAIR FEE = 578.00/hour (3 hours minimoNFACILiTY) = 5234.00 minimm s <br /> M) TRANSFER FEE = 320.00 I I UNAUTHORIZED RELEASE EVALUATION - 578.00/hr S <br /> S.I <br /> CI CONSULTATION FEE = 578.00/hr I I SAMPLING INSPECTION FEE - S78.JO/hr S <br /> TOTAL DUE s <br /> FOR OFFICE USE ONLY <br /> SWEEPS S CCMPUTER LOC CODE I DIST CODE AMOUNT RECEIVED C4ECX /CASH_ RECEIVED 3Y DATE RECEIVED = <br /> SS <br /> E4 Z3 032 (REVISED 10-28-93) Page 11 <br />