Laserfiche WebLink
. SAN JOAQUIN COUNTY PUBLIC HEALTH SZ2 VI* <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND S70PACEE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F' I <br /> FACILITY ADDRE$,4-r.tqq /' 517E PHONE with AREA CCOE <br /> ITY STATE ZIP CODE # of TANKS <br /> at SITE <br /> A APPLICANT/BILLING NAME _ APPLICANT CONTACT NAME <br /> L '' I Wlr) <br /> 1 MAILING ADDRESS APPLICAN PHONE R WITH AREA CODE <br /> C <br /> A _ <br /> N CITY STATE 1Z P ucww ' � TYPE of APPLICATION <br /> T CLOSURE, INSTALLATION, etc. <br /> A <br /> ES TOTAL <br /> C 7 <br /> 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) _ $100.00 <br /> 1 <br /> V <br /> S <br /> E TANK FEE = $50.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F Tanks = �, 1986 19871988 1989 1990 1991 1992 1993 1994 1995 t99b <br /> A (multiply by fee for <br /> C each year applicable) �G� 610 <br /> G � <br /> 1 <br /> L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 <br /> 1 <br /> T « Tams x $56.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) <br /> �/ � S 1 Z <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. *(s) <br /> C <br /> L CLOSURE FEE = S53.DO per hour (3 hours minimum per TANK) # TANK(s) X $159.00 = S <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. #(s) <br /> R <br /> TEMPORARY CLOSURE FEE = $150.00 each TANK TANK(s) X '$150.00 = S <br /> P PLAN CHECK (Install. Plan Review & Construction Inspections) TANK I.D. R(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - S53.00 per hour (8 hours minimum per Facility) = $424.00 minim.rn $ <br /> LEAIR FEE (workplan review & construction inspections) TANK 1.0. R(s) <br /> K REPAIR FEE = $53.00 per hour (3 hours minimum/TANK) TANK(s) X 5159.00NG REPAIR FEE = $53.00 per hour (3 hour minimum per facility = S159.00) 5 <br /> FMTOR ANSFERFEE = $20.00 UNAUTHORIZED RELEASE EVALUATION = 553.00/hrNSULTAT]ON FEE = 553.00/hr SAMPLING INSPECTIDN FEE = 553.00/hr $ <br /> TOTAL DUE Sj�? <br /> OFFICE USE ONLY <br /> «, y.:..... MroMea ssxvP»vo MOhV WPiaq M.e xro xcc.cete:»e>e.:e,p..aw.w,yea,u.w:i:;:xa,.ro xw uew. m.s.eco•••• •.•• ..• ........•... ..... . <br /> COMPUTE; <br /> . "".'C'ii'�:li tL• Y n..; zC�,L.7 ,...3 ��y"' <br /> PPPaaO .POOPS Me0 Maaw Maalbe4o Mao label <br /> COMPUTEK ;. L04 �'CO: I'S' CC E 11rIOURrZC}1I) <br /> 1. <br /> ��°Vnl��1� <br /> a. <br /> U r11t h�tElw <br /> ....v S'..C.iX:6Qt.;�y.'GLG y`�:S >�a1 M6P M0®a 041 JPPnaP 1o06lpi�Ma/+a MCa. %Oa MbeaMR alaeal N.ao Aeo Leve )a OO MPbaiiOe MJO Ma00o iPWMwl fbe M»]PMYM»MM Mbeo iae_M_ <br /> EH 23 032 rREv `/8/91) fit <br /> Pace 11 <br /> 1 <br />