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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVtRCNMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM • fEE WORXSHEET <br />[[FITY SITE NAME FAClL fTY CONTACT NAME <br /> ITY ADDRESSPHONE $ Wlth AREA GWE <br /> STATE ZIP CCOE a of TANKS <br /> V—SC_A to et SITECANT/BILLING NAME APPLICANT CONTACT NAME <br /> SK 5c 'Rt)beer APPLICANT PHONE N WITH "AREA CODE <br /> NG ApORESS TU �oX S <br /> STATE ZIP CODE TYPE of APPLICATION <br /> S qI0 C� 9eJ 3ZU CLOSURE, INSTALLATION, rte. (2 10 SL4 R£. <br /> TOTAL <br /> A <br /> C 1986 1987 1 1988 7989 1490 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) c $100.00 <br /> t S <br /> V <br /> E TANK FEE S50.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> HE <br /> F tl Tonka + _ 1985 1987 1988 1989 1990 1991 1992 1993 1994 1945 1996 <br /> A (sultIPLY by fee for <br /> C each year applicable) S <br /> I <br /> L STATE SURCHARGE - S56.00 each TANK (Due #very 5 years) See Ca(ffornla H b S Code, Section 25287 <br /> I <br /> T N Tanks x S56.00 1986 through 1990 1991 through 7996 <br /> Y (enteramount and year) <br /> s <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK N(s) <br /> C q <br /> L CLOSURE FEE • S53.00 per hour (3 hours minimum per TANK) TANK(S) % f159.00 • �5/ D o <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review b Inspections i K 1.0. 0(5) <br /> R <br /> E TEMPORARY CLOSURE FEE s 5150.00 each TANK Y TAN % 5150.00 • S <br /> P PLAN CHECK (Install. Plan Review 6 Construction Inspections) TANK I.D. N(S) <br /> L <br /> A <br /> N PLAN CHECK FEE - $51.00 per hour (8 hours minimum per Facility) = $424.00 minimum f <br /> R REPAIR TANK I.D. 1f(0 <br /> E <br /> P TANK REPAIR FEE + S53.00 per hour (3 hours mfnimum/TANX) M TANKS) _ X S159.00 s S <br /> A <br /> 1 <br /> R PIPING REPAIR REVIEW b CONSTRUCTION • S53.00 per hour (3 hour minimum per facility = $159.00) % <br /> M CC SULTATIOHS UNAUTHCRIZED RELEASE EVAWATI04 SAMPLING INSPECTION <br /> 1 <br /> S <br /> C FEE • 553.00/hr FEE 553.00/hr FEE = S 53.00/he <br /> TOTAL DUE S S o D <br /> OFFICE USE ONLY _ <br /> M 4.1 YJ Tr+ Y yq}YIM <br /> cNEc4°uic;Cs"N <br /> e s <br /> w a++��i...eivr>r,i�:.�.r .._......,..,. ..�v�'..wu v�.�rv.0 rw...,.....au s++m:.+wae:rc• <br /> .s+mwmr•rw•worm�n:e,srr�are:rao mn x•sras sea-n^s•�.—_. -. . <br />