Laserfiche WebLink
y S&ACUIN COUNTY FJSLIC HEALTH SERVICES <br /> EERVIRC14MENTAL HEALTH DIVISION <br /> UNDERGRCUND STORAGE TANK PROGRAM - FEE XRXSHEET <br /> FACILITY CONTACT AME <br /> EAL,11,Y NAME <br /> r <br /> SITE PHONE # with AREA CODE <br /> ESS 'r f - t/`7 L' Gv ', Pi /u G' of TAxXS <br /> STATE ZIP CODE< at SITE <br /> APPLLING NAME <br /> APPLICANT CCNTACT NAME <br /> P rw.. <br /> L APPLICANT PHONE 4 WITH AREA CODE <br /> I MAILING A130RESS G, -4 - <br /> 110 <br /> STATE ZIP CODE TYPE of APPLICATION f vr? 5 c,0rr <br /> N CITY !! ff t `� CLOSURE, INSTAL ATICN, etc. <br /> An <br /> 17 <br /> TOTAL <br /> A 1986 11987 1988 1489 1994 <br /> C <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 S <br /> I - <br /> V (prior to January 1,1991) 5170/TANK (after Jaruary 1, 1991) <br /> E TANX FEE = 350.001TA}IK <br /> F Tanks = 1986 1987 1988 1989 1.940 1941 1992 1993 1994 1995 1996 <br /> A (rr"ltiply j by fee for S <br /> C each year applicable) <br /> I <br /> (Due every 5 years) See California H & S Cade, Section 25287 <br /> L STATE SURCHARGE = S56.00 each TANK <br /> I <br /> T T T arks x 556.00 <br /> 1986 through 1990 1941 through 1996:: <br /> Y (enter amount and year) HSE <br /> PER.W BT CLOSURE (Removal or Authorized CLosure-in-Place) TANK I.D. #(s) <br /> C ; <br /> L CLOSURE FEE = 553.00 per hour (3 hours minimum per TANK) 4 TANK(s) X 5159.00 = <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. ;#(s) <br /> RS <br /> E TEMPORARY CLOSURE FEE = 3150.00 each TANK TANK(s) X $150.00 = <br /> P PLAN CHECK (Instal L. Plan Review & Construction Inspections) TANK I.D. 1(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minimuo per Facility) = 5424.00 minimus S <br /> R REPAIR FEE (workplan review & construction inspections) TANK I.D. '(s) <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minim nVTANK) 'A TANK(s) X S159.00 = S <br /> A <br /> I <br /> R PIPING REPAIR FEE = $53,00 per hour (3 hour minimun per facility = S159.00) S <br /> M CONSULTATIONS \ UNAUTHCRIZED RELEASE EVALUATICN SAPLING INSPECTION <br /> I` <br /> 1 <br /> I <br /> 'C FEE = S53.00/hr 1412 PEE = 553.00/hr FEE = 5 53,00/hr <br /> �.� TOTAL OUE S �q 1 <br /> OFFICE USE ONLY I �_ „,,,,. <br /> ]M.iW�..M fMMFfM.YW1].Y�.YM.�IY�MO.Y.fw.fWM#r�)M..�O.w.lwM yWl ]M�M�UIIYrIM.IY�M.►1Mr�l��s.�fw.MM.�11�Y1Mlfww�YwF]Mw�MMIMWY.�]r�YY��wfwwYl.YY....�1W�wR rwFlW awl�...�'�. <br /> -CAW <br /> mm"aw mow <br /> Y.. .._ ......,.. ..��.. .,....�......r..,,...�.�..,._�. y.. .. ,.... .,...._ .a..�..:.y..y.:�.:��. . _ ...::,�,...:�......A..k....��.:::.:_� <br /> EH 23 03Z [REV 1/10/911 ft Pace 11 <br />