COMPLIANCE INFO 1988 - 2002 - Laserfiche WebLink

Home Browse Search

Nay 24 01 00: 12a RjfUNZICKER 1 f 537 1573 p. 3 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET FACILITY NAME FACILITY CONTACT NAME / JU rbc / lr O jr f7 U C? 9 Nn FACILI ADDRESS STEP E#WITH AREA CODE ZIP CODE �3 �#OF TANKS AT SITE fiGa CA —� APPLICANT BILLING NAME APPLICANT CONTACT N�AMME (Z'.�r' G/�G4Y)'I— APPLICANT GAPPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE O o 1 Z/" 5-�3 -6eJ3 3 C STATE ZIP CODE CIRCLE WORK TO BE DONE: Closure Installation epair Retrofit ACTIVE FACILITY t� 1996-1999 2000 2001 $500 FEE INCLUDES FACILITY FEE+ 1 TANK (5170)X(#tanks)X(#of years applicable) $125 PER TANK AFTER FIRST TANK $ $ TANK PENALTY ASSESSED $ TANK SURCHARGE=S8/TANK $ STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY INA CUPA PROGRAM-$10/FACILITY PERMANENT CLOSURE Removal or Permitted Closure In Place $ TANKID# 5 CLOSURE FEE=5261/TANK #TANKS X 5261= TEMPORARY CLOSURE (Plan Review and Ins eclions) $ TANK ID#(s): TEMPORARY CLOSURE FEE_$261 /FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Ins eclions $ TANK ID#(s): PLAN CHECK FEE_$696/FACILITY REPAIR PLAN CHECK, , - TANK ID#(s): TANK LINING REPAIR FEE _$2111 TANK #TANKS X$261 = $ TANK RETROFIT REPAIR FEE =$261 /FACILITY $ PIPING REPAIR FEE = 261 /FACILITY MISCELLANEOUS $ TRANSFER FEE _ $20 $ CONSULTATION FEE = S 87/HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = S87/HOUR $ SAMPLING INSPECTION FEE = S 87/HOUR ALL FEES ARE BASED ON THE 567 HOURLY RATE. TIME THAT E%LEEDS FEES PAID WILL BE BILLED TO APPLICANT. OFFICE USE ONLY SERVICE REQUEST# 11 FACILITYID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED SR EH 230321REVISED 2-6-01)