Laserfiche WebLink
SAN JOAOUtN COUNTY PUBLIC HEALtH SERVICES <br /> ENVIRONMENTAL HEALTH O M SIOH <br /> UNDERGROUND STORAGE TANK PROGRAM FEE 'WCRKSHEET <br /> kPACtLITY <br /> CTLITY SITE MARE FACILItY CONTACT NAME <br /> AC <br /> t ADDRESS �j� SIZE PHONE ! with AREA CCOE <br /> 1/9I <br /> T CITY STATEIIP CODE f] of TANKS / <br /> Y ' -7 At SITE / <br /> A APPLICANT/BILLING NAM APPLICANT CONTACT NAME <br /> P <br /> L <br /> I MAILING ADDRESS APP LICAN t PH E 0 111TR-AREA C00E <br /> C C( cJ 7 fr/ D 7 <br /> A CIS — 3 6 5--— �l/ <br /> � <br /> N CITY � STATE YIP CODE TYPE of APPLICATION <br /> CLOSURE, INSTALLATION, ete. s <br /> — TOTAL <br /> A <br /> C 1486 1481 1989 1999 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) • !100.00 <br /> I ! <br /> v <br /> E TANK FEE = 550.00/TANK (prior to January 1,1991) 1170/LANK (Aftar Jam" 1, 1991) <br /> F 0 Tanks = 1996 1987 1988 1989 1990 1991 1992 1993 1994 t995 1996 <br /> A (mrrtiply d by fee for <br /> C each year appliceb(e) C� <br /> 1 <br /> L STATE SURCHARGE * 156.00 each TANK (Due Avery year!) See Callforni8 H 3 3 Codi, UctlBn 25287 <br /> t <br /> T a Tanks x 156.00 1996 through 1990 1991 through 1996 <br /> Y (enter amount and year) <br /> PERMANENT CLOSURE (Removet or Authorized CtosUre-in-Place) tANK 1.0. 0(S) <br /> C <br /> L CLOSURE FEE a IS3.00 per hour 0 hours irtlnl" per TANK) It tANK(s) X 9159.00 a 3 <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A ahe-time plrMit, for revtN t Inspection! tANK I.O. eft) <br /> R <br /> F TEMPORARY CLOSURE FEE : !150.00 tech tANK 0 tANK(s) X !150.00 � ! <br /> P PLAN CHECK (Install. Plan Rev(eu 3 ConStrUctlon Inspections) TANK I.D. Oct) <br /> L <br /> A <br /> N PLAN CHECK FEE 153.00 per hour (A hourt iTflnWm per FBctttty) ! W4.00 fhlnimL0 f� Z/' <br /> R REPAIR 1ANK 1.0. Im <br /> e <br /> P TANK REPAIR FEE a $53.00 per hour (3 hours minimum/TANK) 0 1ANK(3) X 3159.00 A 3 <br /> A <br /> 1 <br /> R PIPING REPAIR REVIEW 2 CONSTRUCtION A 153.00 per hour (I hour MjIMtaltfll per facility A 3159.00) ! <br /> M CONSULTATIONS UNAUTHORIZED RELEASE EVA LIAtIO0 SAMPLING INSPECtION <br /> I <br /> s <br /> C FEE - 353.00/hr FEE + E53.00/hr FEE ! 53.00/hr <br /> - TOTAL DUE 3 ' = <br /> CFFTCF USE <br /> •�fiw•iwi r.+w Iw xNvi:+si 7iwni rµ.r'l.aei:i:•WMA•M vYN:�be fr!i?%i'n"M Taxi xamwW.al 1pesm a.•a.I.dNM vn.rilF si rii•ri•iw!.uii ai i.n iW•�sN.r.►s frw Mwii iW <br /> s'�' =rs '�•�o '" '&sro� "" is ccu IcEfliT'kc 1� C.:. /.CAS c i""a"I " " t'pt °"'�" ` mw No <br /> 622 <br /> ��:;...� iww�:rsw�i:u•:`.:.•w nei�«.iwwer xw+ew Yu°oro •a• +�:�•� •! <br /> Jj�'• ^ti+ati ia!tiwfrww•�+incroxa=�riw•� w.•rw ww�ri`w r»i..r ri•u`wr�.=i►w:.�.�`..irs � <br /> /��/��9"�s�sr� ^�r.�lYw/Mf I�YMAR 91CCI C]t lll��fyT.:,...9'f.,.fF,�df s?•S:k1F'd",.{'7°X7;7'!S f�X,.,.".,.""^.,.Y:"�Z:F.'S;7�#°.1�;�5^X'::'::Y"S'9,.a'f�"U ASY:: s�Y�It fMMit eM//Mrf/li llMi:lMl AlMte�f�if�i7K Ali 1rK � <br />