Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVSIOW <br /> U ERGROUND STORAGE TANK PROGRAM - FEE LIORXSHEET <br /> SI FACILITY SITE NA7j FACILITY C HT NAME f <br /> I / <br /> T <br /> El FACILITY ADDRESS1 I XITE PHOT wish AREA <br /> � � I <br /> D � 1 <br /> CITY STATES z P CODE { of TANKS <br /> Al P (� '{�/ at SITE <br /> P• " V � i 5 <br /> PI APPLICANT/BILLING HAM AP� 2L&&&� P ICAN CONTACT N E i <br /> Ij t <br /> ! / ! <br /> CI MAILING ADDRESSA P/_ICAH PHONE '' WITH AREA CODE <br /> N I— <br /> T ' I rATE if ' P tC�De3� TYPE of APPLICATION <br /> (Closure, Ins,aliation, etc.) <br /> TOTAL <br /> I 7986 1987 7988 i 1989 11990 <br /> ANNUA'.. FACIL7TY FEE (Prior to January i, 1991) = S100.00 <br /> j A! I XXXX XXXX ' XXXX XXXX XXXX S XXXXXXXX <br /> g C i <br /> T', FACILITY PENALTY FEES ASSESSED Cl.f Applicable) XXXX XXXX j XXXX XXXX I XXXX S XXXXXXXX <br /> I <br /> 6 <br /> V' TANK = 576.00/TANK (Prior to January 1,7991) i S170/TANK (After January 1, 1991) <br /> f <br /> Y' = Tanks 1987 1988 1989 f 1990 1991 1992 1993 11994 1995 i 1996 j 1997 <br /> F (multioly R 5y tee for ; <br /> C each year applicable) XXXX XXXX XXXX XXXX IXXXX I, i I S k <br /> B <br /> I <br /> a I; TANK PENALTY =;-5 ASSESSED XXXX XXXX 1 XXXX I XXXX iXXXX ' <br /> L <br /> 11 STATE SURCHARGE FOR NEW FFACILITIES ONLY = $18.50 �5 <br /> T' <br /> Y: t Tanks x $8.00 1988 through 1990 (S56) 1991 through 1995 (S56) 1997 <br /> SURCHARGE FOR 1997 XXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXKXXXXXXXX S <br /> C� PERMANENT CLOSURE (Removal or Authorized CLosure-in-Place) I TANK I.D. _'(s) <br /> L. <br /> 01 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) ! s TANK(s) X 5234.00 = 5 <br /> S' " <br /> UI TEMPORARY CLOSURE (Plan Review $ Inspections) TANK I_D_ :(s) <br /> R, <br /> E} TEMPORARY CLOSURE F_- = S78.00/hour (3 hours minimum/FACILITY) SZ34.00 minimum S <br /> I <br /> q P! iNSTALLATION PLAN CHECK (plan Review 3 Construction Insaec:ions)I TANK 1.D. M(s) a <br /> g L <br /> Al <br /> N} PLAN CHECK FE- = S78.00/hour (8 hours minimum/FACILITY) = S624.00 minimum S <br /> R REPAIR FEE (uorkpLan Review 8 Construction Inspections) I TANK I.D. '(s) <br /> E ! <br /> PI TANK LINING REPAIR FEE = S78.00/hour (3 hours minimum/TANK) # TANK(5) X 5234.00 = S <br /> A y� <br /> I+ TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = 5234.00 minimum 1 S <br /> R 1 <br /> PIPING REPAIR FEE = S78-00/hour (3 hours minimum/FACILITY) = S234,00 minimum , S <br /> F! TRANSFER FEE = $20.00 I UNAUTHORIZED RELEASE EVALUATION = S78.00/hr S <br /> S <br /> Cj CONSULTATION FEE = S78.00/hr I SAMPLING INSPECTION F=E = S78.00/hr 6 S <br /> TOTAL DUE S <br /> FOR OFFICE USE ONLY <br /> —�..--.-_._. — ._......_._....._—...._... <br /> _SWEEPS � � COMPUTER N I LOC CODE I DIST COOL � AMOUNT RECEIVED � CHECK "/CASH I RECEIVED 3Y I DATE RECEIVED <br /> r <br /> EH 23 032 (RFVISPn S-P7-07% <br />