Laserfiche WebLink
SAN UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> N <br /> FACILITY NAME FACILITY CONTACT NAME <br /> silveria property mr jack bozzano 209 467-8320 <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 1933 hiawatha avenue 209 467-8320 <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> Stockton ca CA 95205 one <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> quality packing shippin ack bozzan0 209 467-8320 <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> po box 5009 209 467-8320 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE: <br /> Stockton ca 95205 )QXqure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> 1996- 1999 2000 2001 <br /> $500 FEE INCLUDES FACILITY FEE+ 1 TANK ($170)X(#tanks)X(#of years applicable) $ <br /> $125 PER TANK AFTER FIRST TANK <br /> TANK PENALTY ASSESSED $ <br /> TANK SURCHARGE=$8/TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$10/FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID# s : CLOSURE FEE=$2611 TANK <br /> TEMPORARY $CLOSURE j /_ <br /> Plan Review and Inspections) $ <br /> TANK ID#(s): TEMPORARY CLOSURE FEE=$261 /FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Ins ecfions $ <br /> TANK ID#(s): PLAN CHECK FEE=$696/FACILITY ^ b <br /> REPAIR PLAN CHECK ^3� <br /> TANK ID#(a): $ <br /> TANK LINING REPAIR FEE =$261 /TANK #TANKS X$261 = <br /> $ <br /> TANK RETROFIT REPAIR FEE =$261 /FACILITY $ <br /> PIPING REPAIR FEE _$261 /FACILITY <br /> MISCELLANEOUS <br /> $ <br /> TRANSFER FEE _ $20 $ <br /> CONSULTATION FEE = $87/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $87/HOUR $ <br /> SAMPLING INSPECTION FEE _ $87/HOUR <br /> ALL FEES ARE BASED ON THE$87 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK# RECEI�BYDATERECEIVED <br /> SR L <br /> EH 23 032(REVISED 2E-01) <br />