Laserfiche WebLink
��,a�c�-d �i��-- `1� � N rel lad-ia►J -Pla�1 -�LtA�.c1�,,.�1�-- <br /> SAN JOAOUIWNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAAWLTH DIVSION <br /> DERGROUND STORAGE TANK PROGRAM - FEE WORKS <br /> S FACILITY SITE NAME FAC LI TY CONTACT AME <br /> I �Fafc� t <br /> T <br /> -E FACILITY ADDRESS SITE MONE # with AREA CODE <br /> & 00S. X71 0 <br /> CITY STATE ZIP CODE # of TANKS <br /> A LAt�,-(2.D at SITE <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L <br /> I A-wvc— <br /> C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> A <br /> N <br /> T CITY STATE ZIP CODE TYPE of APPLICATION <br /> (Ctosure, Installation, etc.) <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br /> A XXXX XXXX XXXX XXXX XXXX $ XXXXXXXX <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XXXX XXXX XXXX XXXX $ XXXXXXXX <br /> I <br /> V TANK FEE = 550.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E �'" ' <br /> # Tanks = 1 1988 1989 1990 1991 1992 M1994 1995 1996 1997 199 LyW�b 5D54p <br /> F (multiply # by fee for <br /> A each year applicable) XXXX XXXX XXXX XXXX XXXX + O S 0 <br /> C <br /> I TANK PENALTY FEES ASSESSED XXXX XXXX XXXX XXXX XXXx <br /> L <br /> I STATE SURCHARGE FOR NEW FACILITIES ONLY=518.50 S <br /> T <br /> Y # Tanks _ x $8.00 1988 through 1993 (556) 1993 through 1997 ($56) 1998 <br /> SURCHARGE FOR 1998 xxxxxxxxxxxxxxxxXXXXXXXXxxx XXxxxxxxxxxxxxxxxxXXXXX $ tip <br /> C PERMANENT CLOSURE (Removal or Authorized CLosure-in-Place) TANK I.D. #(s) <br /> L <br /> 0 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X 5234.00 = $ <br /> S <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = 578.00/hour (3 hours minimum/FACILITY) $234.00 minimum $ <br /> P INSTALLATION PLAN CHECK (PLan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = 578.00/hour (8 hours minimum/FACILITY) = 8624.00 minimum $ <br /> R REPAIR FEE (Workplan Review & Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = $ <br /> A <br /> I TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) = $234.00 minimum $ <br /> R <br /> PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) = $234.00 minimum $ <br /> M TRANSFER FEE = $20.00 UNAUTHORIZED RELEASE EVALUATION = $78.00/hr $ <br /> I � <br /> S <br /> C CONSULTATION FEE = $78.00/hr SAMPLING INSPECTION FEE = 578.00/hr $ <br /> TOTAL DUE $ t-1ab <br /> FOR OFFICE USE ONLY lc7� <br /> SWEEPS COMPUTER # LOC CODE DIST CODE AMOUNT RECEIVED CHECK #/CASH RECEIVED BY DATE RECEIVED <br /> 5 <br /> ........................... -n ..... - <br /> ................... ........._._......... _ .... <br /> .........................................................................:............:::......::::::-_::::..::�:::_:::....:..._,::::__::::��-::::::-:::-::::::::-:::::_—:::..::�:::-,.._:::::::::::::::::::::::::::.::L_..__-::....:..::::._::::.-::::-:::::::::.:....:..:�:::::::::::::-:-_:::::::::::.. <br /> iiiiiiiiiiiiiiiiiiiiiiiiii . isiiiiiiiiiiiiii�_ii€isisisi=���_iHiiiiiiiii_:[�_ iHiiiHii_:_i:[[[:t=:::_.:[::[:_:a::[_;:[ _�::: :::::::::::::::::ta::::c[::te::et___.._..:::-_;_:.:::__: :::::::::.:::::::::::::::::::..:,::::.::::::::::.::::::::.:::::::::::::_:::::: <br /> EH 23 032 (REVISED 1-12-98) <br />