Laserfiche WebLink
SAN OAQUIN LOCAL HEALTH DIORICT <br /> ERGROUND STORAGE TANK PROGRAM - FEE WORKSHE <br /> FiFACILITYISITE NAME _ FACILITY CONTACT NAME <br /> IWITH AREA CODE <br /> L STREET AADDDRESSS. ` SITE PHONE <br /> 31 . l j <br /> Y CITY SKATE IIP CGDE # of Tanks <br /> - ?�'C- k-) i� at Site <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P <br /> I MAILING ADDRESS APPLICANT PHONE # WITH ARIA CODE <br /> N CITY STATE IIP-CODELim of APPLICATION <br /> 06L1RIr INSTALLATION, ETC. _ <br /> FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR � TOTAL <br /> C 1986 1987 1988 1189 <br /> T - <br /> I $ <br /> V <br /> E TANK FEE = $50.00 each TANK <br /> F # Tanks _— x 150.00 —- -1985 1987 1988 1989 <br /> A (multipTy 1-by fee for --- ---� <br /> C each year applicable) _ $ <br /> I- — <br /> L STATE SURCHARGE _ $55.00 each TANK (see CA HEALTH & SAFETY CODE Sec 25287 for applicability) <br /> T I Tanks - x $56.00 1986 1987 1988 1989 �C€vV EEO <br /> Y (enter aa!uunt and year) — --- _— <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) 1H <br /> vl <br /> 0 CLOSURE FEE = $90.00 each TANK # Tanks____-- x 190. PE MfT1SWICES <br /> S —---- <br /> U <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E- ------- -- — <br /> TEMPORARY CLOSURC FEE = $80.00 each TANK I Tanks i—x $80.00 - s <br /> P PLAN CHECK (Installation or Repair) <br /> IN PLAN CHECK FEE -- 130.00 each SUBMISSION/RESUDMISSION $ �j <br /> 1.--I.R E P A I—R ---- <br /> 2 <br /> __._._.-2 TANK REPAIR FEE = $110.00 each TANK — �>« Tanks x $110.00 <br /> A PIPING REPAIR,/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> I — <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (when applicable) - — (when applicable)— (when applicable) <br /> FEE = $20.00/hr FEE = $35.00/hr FEE _ $35.00/hr <br /> TOTAL DUE $ <br /> OFFICE USE ONLY <br /> R <br /> SWEEPS # COMP A LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK #/CASH RCVD BY DATE RECE�IyV�E7D PERMIT <br /> ...---. .. ....._. .... _./� ._...,- °im �`° `o.. ,-... � �Ico .....�._....---.q.� L.._..'_ _ry.... _-.....-........_����'1 I �,.R�m ! I NLIIi�ky <br /> it, ° ��nn ��,, °lll I IruillG� " R °Irt�m��nn � pmm e91011937019m, <br /> hh <br /> -!r ,I�°��'�lI IJ11'1111 Q lir°j!r!.,I!!d4� � !: I. /!call) 7., '1��l,c!' oI!tuuis!wur';�illl �l� Imfu .�ul�� ������I���Itl�, ,i �����Vl <br />