Laserfiche WebLink
SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> T • UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> • fF FACILITY/SITE NAME FACILITY CONTACT NAME <br /> A <br /> C Harney Lane Sanitary Landfill Tom Horton <br /> I --- <br /> L STREET ADDRESS SITE PHONE t WITH AREA coos <br /> i 14750 Harney Lane (209) 368-4525 <br /> Y CITY STAT ZIP CODE t of Tanks <br /> _Lodi --,.-- _ CA 95240 —_— <br /> A APPLICANT/BILLIN6 NAME APPLICANT CONTACT NAME <br /> P San Joaquin County Department of Public Works <br /> P Solid Waste Division Rudy Rodriguez <br /> L - ...__ _ <br /> I MAILING ADDRESS APPLICANT PHONE 1 WITH AREA COD[ <br /> C 1829 E. Hazelton _ (209) 468-3066 <br /> M CITY -�� — STAT iIP'CODE TYPE of APPLICATION <br /> T Stockton CA 95205 CLoeuRe, INmTALLATImN, 'IC- <br /> Removal--FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR TOTAL <br /> A F <br /> --_ ._ - ---- - -._—.—— <br /> T 986 (987 _1988 -- <br /> V - f <br /> E TANK FEE _ $50.00 each TANK <br /> F t Tanks x $50.00 1986 1987 1988 1989 8 <br /> A (multiply-t-by fee for -- <br /> C each year applicable) � — f <br /> I — -- <br /> L STATE SURCHARGE _ $56.00 each TANK (see CA HEALTH It SAFETY CODE Sec 25287 for applicability) <br /> -- -4 <br /> T t Tanks x $56.00 1986t981 1988 1989 <br /> Y (enter aiount and year) <br /> $ <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) —� <br /> L ---- —-- __ -- -. __ ---- — <br /> 0 CLOSURE FEE _ $90.00 each TANK ! Tanks x (90.00 $ 90.00 <br /> U ------- <br /> P. TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> TEMPORARY CLOSURE FEE _ $80.00 each TANK ! Tanks x $80.00 f <br /> P PLAN CHECK (Installation or Repair)L— <br /> A —A <br /> N PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION f <br /> .- .REPAIR ---.___.— <br /> P. TANK REPAIR FEE _ $110.00 each TANK1 Tanks z $110,00 f <br /> E-- -- - <br /> P -------- <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> I ---- -- <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION LF <br /> MPLING INSPECTION <br /> (when applicable) (when applicable) hen applicable) <br /> - FEE _ $30.00/hr� --_— FEE _ $35.00/hr �— — E _435_00/hr <br /> TOTAL DUE $ 90.00 <br /> OFFICE USE ONLY <br /> DII!@7�G IGG NGI�IGG M.11 IGI9'PIT J11�1iG.IIGI 11, 11 11 W. 1111115 i9fi1GGGNIGG1GIIGPiI5GGGG!IGVGGGGV!Ialn1Ilii%l <br /> SWEEPS 1 COMP t LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK t/CASH =DATE PERMIT t <br /> � ......--._.... ._.. — <br /> ,, , �G9G pl11P TI it III i, ,I! GG ILII!!! GGGGIGGGGGGIIIC!i!ild!G .�11iG:�IIGGGG!IG!GiIGiIG G1G1111111m:G ,GGi' <br />