Laserfiche WebLink
SAN OAQUIN LOCAL HEALTH DARICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE NORKSHEET <br /> r FACILITY/SITE NAME FACILITY CONTACT NAME <br /> A G��F <br /> ( .�2���_R_c�^ moi✓ c Lam.3SITE PHONE WITH ARRA eeee <br /> L STREET ADDRESS ��� <br /> r STAT IIP CODE 1 of Tanks <br /> at Site <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P _ D) ry.� E—1,yF eA <br /> I M LNG AD APPLICANT PHONE 1 WITH ARRA come <br /> N CIJX, 1 STAT 11P C0 cioiuef APlPLICATIONRN, ETC. <br /> T i`�COJ/�CoJ\ ------- — <br /> FACILITY FEE - 1100.00 each SITE ADDRESS per YEAR TOTAL <br /> A . - --- ---.----. <br /> C 1986 1981 19(18 1989 <br /> I 1 <br /> V -- -- ------ -- - - <br /> E TANK FEE s 150.00 each TANKez-IL <br /> _-.__...._.............._...__. ._. ...._._ : �'�� .?rte. - __..--- <br /> F 1 Tanks1150.00 1986 19(11 19(18 1989 <br /> A (wltiDf"y 1_by lee for <br /> C each year applicable) d <br /> 1 -- <br /> LSTATE SURCHARGE z 156.00 each TANK (see CA HEALTH 1 SAFETY CODE Sec 25207 for applicability) <br /> I 1 Tanks____ 1 156.00 - 1986 1981 1988 1983 <br /> Y (eniet .Ruuot and year) TIF jI <br /> .._. ...._..�1-.—� <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) —_-- <br /> L - ------------_.._— 1 Tanks 1 (90.00 <br /> 0 CLOSURE FEE 190,00 each TANK �— _ _ — — <br /> U --— ----- --- <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two Yeats) — <br /> TEMPORARY CLOSURE FEE = 180.00 each TANK 1 Tanks------ 1 180.00 1 <br /> P PLAN CHECK (Installation or Repair) <br /> L -- <br /> A <br /> M PLAN CHECK FEE = 130.00 each SUBMISSIONIRESUCMISSION _— <br /> REPAIR <br /> P. TANK, REPAIR FEE = 1110.00 each TANK 1 links------ 1 1110.00 f <br /> E - —.._- -- -- -......_--- ----------- <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hourp minimum one hour to he paid on plan- submittal) -- <br /> R UNAUTHORIlEO RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING 111SPECTION <br /> (ehen applicable) (when applicable) (vhen applicable) <br /> . .---_---------- <br /> FEE 130 00/hr� FEE = 135_00/hrL FEE • 135.00/hr 1 <br /> TOTAL DUE %:3V Oo <br /> OFFICE USE Oety l <br /> SWEEPS 1 COMP 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK 1/CASH RCVD BY DATE RECEIVED PERMIT t <br />