Laserfiche WebLink
SAN JOA• COUNTY ENVIRONMENTAL HEALTH DEPA�ENT <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> FACILITY CONTACT NAME <br /> FACILITY NAME ,13 /* / <br /> SITE PHONE#WITH AREA CODE <br /> FACILITY ADDRESS <br /> Y8 S S <br /> CITY IPC q y - OF A a <br /> STATE ZIP CODE #OF TANKS AT SITE <br /> CITY <br /> l APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> APPLICANT PHONE If WITH AREA CODE <br /> APPLICANT MAILING ADDRESS <br /> �C G (2� �3 / ZIP CODE CIRCLE WORK TO BE DONE: <br /> CITY STATE <br /> C 9 z L2 /. 7— Closure Installation epai Retrofit <br /> Dx 4-?.j c- e C/(J <br /> ACTIVE FACILITY <br /> 1997- 1999 2000 2001 200 <br /> $500 FEE DES FACILITY <br /> TANK <br /> 1TANK ($170)X(#tanks)%(#N years applimble) $ <br /> $125 PER TANK <br /> $ <br /> TANK PENALTY ASSESSED $ <br /> TANK SURCHARGE=$10/TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$17.50/FACILITY <br /> PERMANENT CLOSURE $ <br /> Removal or Permitted Closure in Place <br /> CLOSURE FEE_$267/TANK #TANKS X$267= <br /> TANK ID# Is <br /> TEMPORARY CLOSURE $ <br /> Plan Review and Ins ections <br /> TEMPORARY CLOSURE FEE_$267/FACILITY <br /> TANK ID#(s): <br /> INSTALLATION PLAN CHECK $ <br /> Plan Check and Construction Inspections <br /> PLAN CHECK FEE_$712/FACILITY <br /> TANK ID#(s) <br /> REPAIR PLAN CHECK <br /> TANK ID# s $ <br /> #TANKS X$267= <br /> TANK LINING REPAIR FEE =$267/TANK $ / .0 <br /> TANK RETROFIT EPAIR EE =$267/FACILITY $ t7 <br /> PIPING REPAIR FEE _$267/FACILITY <br /> MISCELLANEOUS $ <br /> TRANSFER FEE _ $20 $ <br /> CONSULTATION FEE _ $89/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $891 HOUR $ <br /> SAMPLING INSPECTION FEE _ $89/HOUR <br /> ALL FEES ARE BASEDN OTHE$89 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLYAMOUNT RECEIVED CHECK# RECENED BY DATE RECEIVED <br /> SERVICE REQUEST# FACILITY ID <br /> SR <br /> cw <br /> 11 a32(REVISED 3/la-1 <br />