Laserfiche WebLink
SAOJOAQUIN LOCAL HEALTH 133TRICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> IF FACILITY/SITE NAME FACILITY CONTACT NAME i— <br /> C La �/vI,' 1ihS �O /E <br /> L STREET ADDRESS <br /> 1 5 SITE PHONE 1 WITH AREA coma <br /> T— ar' P <br /> Y CITY > J STA E 11P COffD,�— ! <br /> l Tanks <br /> �-2Site <br /> F APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> I MAILING ADDRESS APPLICANT PHONE 1 WITH AREA C009 <br /> N CITY STATE ZIP'CODE APPLIrpTII <br /> �-� INmrALtA -10H-,ETC. <br /> A FACILITY FEE =-1100_00 each SITE ADDRESS per YEAR _ TOTAL <br /> C 1986 1987 1388 1989' - — <br /> 00 <br /> E TANK FEE = 150.00 each TANK <br /> F 1 Tanks r 150.00 1986 1387 1988 1989 — <br /> A (aultiPTy-I by fee for <br /> C each year applicable) o 0 <br /> L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH L SAFETY CODE Sec 25281.7 for applicability) <br /> I - - <br /> T I Tanks a 156.00 1986 19871988 1989 <br /> Y (enter iiount and year) <br /> —E- — 51— <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) -- — --- -- — -- <br /> L -- <br /> 0 CLOSURE FEE = 190.00 each TANK 1 Tanks_- a to0.00 1 o <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> TEMPORARY CLOSURE FEE = $80.00 each TANK I Tanks x 180.00 1 <br /> P PLAN CHECK (Installation or Repair) -- — -- ---—— --- <br /> A -- - ----- _-- _--_-------- - <br /> N PLAN CHECK FEE = 130.00 each SUBMISSION/RESUOMISSION 1 <br /> REPAIR --_--- <br /> R TANK REPAIR FEE = 1110.00 each TANK — <br /> 1Tanks r 1110.00 1 <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION_ <br /> (when applicable) (when applicable) (when applicable) <br /> FEE = 130.00/hr[ - <br /> FEEFEE <br /> _ 135.00/hr _.-135_00/hrl. <br /> TOTAL DUE 1 <br /> OFFICE USE ONLY <br /> '�113i 1 '. 111 IIPG�FlR1YQfll�uli a l � . !7 <br /> RM a ON=ln012mi l=0=11111 I�V?��lil�4�j <br /> SNEEPS I COMP I LOC CDOE DIST CODE AMOUNT DUE AMOUNT RrVD CHECK WASH RCVD BY DATE RECEIVED PERMIT <br /> IE�27`119 R�4 � f.. 33 � 3..S- `/`rg^` ....r,.��%C-x�—._-- C� - -------•------ <br /> �NSsi'I a�ll�� 'R� " y k��,p��pVl��ti✓ !MBI1U�@9�111R�Jl9�yi'MI��W9� 1�CV91Bf�NQ�q�f�Nlh J�Vu11 G�V�IG1�aV�94 . 6i�9aGIG�BW�t6 <br />