Laserfiche WebLink
IRONMENTAL <br /> SAN JOAWIN COUNTYPUBLIC <br /> STORAGEHTANKVPCOS�E-FEES WORKSHEETALTH DIVSIONUND �#o5l la 1 3 <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> I 5" rat <br /> T <br /> 'E FACILITY ADORES SITE PHONE # with AREA CODE <br /> s <br /> A CITY sf0 G Kf-r�� tctxq <br /> E D ` # of TANKS <br /> at SITE / <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L <br /> I <br /> C MAILING ADDRESS APPLICANT PHO E # WITH AREA CODE <br /> A � (a 09 if - 70 <br /> N QO.Oi <br /> T CITY �1�D G / P CODE TYPE of APPLICATION D.� <br /> `J\ LFf (Closure, 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 %%x% xxxx xxxx S xxxxxxxx <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XX%% X%%X xxxx XXXX S XXXXXXXX <br /> I <br /> V TANK FEE is: 550.00/TANK (Prior to January 1,1991) $170/TANK (After January 1, 1991) d1 <br /> E <br /> # Tanks = _ 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 <br /> F (multiply # by fee for 8� <br /> A each year applicable) xxxx xxxx xxxx xxxx xxxx ")( f.W?( kip (1y loo �1 118 tl' ��- <br /> c �I <br /> I TANK PENALTY FEES ASSESSED xxxx %XXX xxxx XXXX xxxx kA K X 1%19 {0 1 0 �� 1 It 0 <br /> L <br /> I STATE SURCHARGE FOR NEW FACILITIES ONLY=S9$�$ S � <br /> T <br /> Y # Tanks I x 58.00 1988 through 1993 ($56) 1993 through 1997 (S56) 1998 <br /> SURCHARGE FOR 1998 xxxxxxxxxxxxXxxxxxxxxxxXXXX XX%XXXxxxxxxxxXX%x%%xxx S •� <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 = S ' 'o <br /> S cL <br /> U TEMPORARY CLOSURE (Plan Review 8 Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = $78.00/hour (3 hours minimun/FACILITY) 5234.00 minimum S <br /> P INSTALLATION PLAN CHECK (Plan Review 8 Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> M PLAN CHECK FEE = $78.00/hour (8 hours minimum/FACILITY) = $624.00 minimum $ <br /> R REPAIR FEE (Workplan Review 8, Construction Inspections) TANK [.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X 5234.00 is S <br /> A <br /> I TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) _ $234.00 minimum S <br /> R <br /> PIPING REPAIR FEE = 878.00/hour (3 hours minim m/FACILITY) _ $234.00 minimum $ <br /> M TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION = 578.00/hr $ <br /> Slt <br /> C CONSULTATION FEE = 578.00/hr SAMPLING INSPECTION FEE = 578.00/hr S <br /> TOTAL DUE S <br /> FOR OFFICE USE ONLY <br /> =�.-iF2iii's iii...........................;;= .................................... . _a-;.=_[::::?:::_':-_.::::_-:::-::: t.„=sr,.__:[_::::;_........... <br /> SWEEPS # COMPUTER # LOC CODE DIST CODE AMOUNT RECEIVED CHECK #/CASH RECEIVED BY DATE RECEIVED <br /> $ <br /> . -ea..._.._.__.::�.,:P[ .:. ._........:::::::: .:::_......:_.........�_......... :_..a::::._..____....._._._::-_:..:...... .._.._ <br /> ...._..._. ._...�._..... ._...................._..... .. ......... a.ert-em___::�......... .... _.... <br /> �..�.:..... ..._......... ... <br /> A, <br /> EH 23 032 (REVISED 1-12-98) <br />