Laserfiche WebLink
SAN JOAQU I N LOCAL HEALTH DISTRICT <br /> RGROUND STORAGE TANK PROGRAM - FEE WORKS �t7 A %' 9 <br /> ... .. <br /> (� <br /> FAIFACI:_ITYfSITE NAME - ~__--�-- FACILITY CONTACT NAME W <br /> L STREET ADDRESS SITE PHONE # WITH AREA CODE <br /> I � 9,A <br /> T --— __— <br /> Y CITY STATE TIP CODE # ofi Tanks <br /> .5Q 5- at Site <br /> A APPLICANTIBILLING NAME APPLICANT CONTACT NAME - <br /> P <br /> P '1 i... Fe A r' <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE _ <br /> N CITYG E ZIP CODE ,IRE APPLICATION <br /> T � CLOSURE. IN97ALLAT ION, ETC. <br /> FACILITY FEE _ $100.40 each SITE ADDRESS.per YEAR--�—�--._..--.�---M.__--------..,_.—,,. TOTAL <br /> A....__....- - -- ...__,.._ _ ....----- _.._-.._..,.. ._ - --..._--- ---....__.........__..,._..... <br /> C 1986 1987 1988 1989 <br /> $_ 360 <br /> --- <br /> V <br /> E TANK FEE = $50.00 each TANK <br /> _ .__....._.........._..__...._.................__. <br /> F # Tanks x $50.00 1986 198T 1988 1989 <br /> A (Multiply_ by flee for <br /> C each ear a licable) <br /> L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH & SAFETY CODE Sec 25287 for applicability) <br /> T I Tanks x $56.00 _--1986 -1987 1988 - 1989 - -- - <br /> Y tenter amount and year) - - ----_ --- ----- -- - .- -_ __ <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L <br /> I CLOSURE FEE = $90.00 each TANK r# Tanks1x $90.00 f <br /> U.....---._......--- - -_-...... <br /> P, TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E ----- <br /> TEMPORARY CLOSURE FEE = $80.00 each TANK # Tanks x $80.00 f <br /> P PLAN CHECK (Installation or Repair) --- -�.~-----•---_�- - -----..—_.__._... <br /> N PLAN CHECK FEE = $30.00 each SUBMISSIONIRESUBMISSION f <br /> REPAIR <br /> R TANK REPAIR FEE = $110.00 each TANK �# Tanks _ _ _ x $110.00 f <br /> £_..___..._-----_._.._-._._..__.__._._....----.-----.-____.__..._._._..._ __.._._____._..._..._._._...._..._..._.._..__..._-.__-_.-____.__.....__.._....__._....._._.-.__..._....._. .._...____ <br /> A PIPING REPAIR,/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid an plan submittal) <br /> I-----------_...----- -- ---- - - . ._.._........ _._..._.--_- - <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (when applicable) (when applicable) (when applicable) <br /> ___ _ _ ____ 9 <br /> FEE _ $30.00IhrI FEE - $35.00Ihr .FEE - 535.00/hr�- ___.- — . f _ ...._._._._..._._.__. <br /> f rra3��� TOTAL DUE 5 <br /> OFFICE USE ONLY =G` (� .c ' ' 13 :5 '0" - <br /> �`n@i��!iltlllIII!'il!�II�IIII�I�N�lllill�iRl��n'Illi�l�!�I�PII1,II�IIil��ll�lllt�l�i�llll!I���Ilii�lill���lIiIIIIIEI(lil{IIIE�IIII,�fl�lllEllPl�l>f11111Cil��iill�Ilq�llllfll�&Ili�ll�llfllllllnC�fi�lfilll llilIIIllllllllllllil�l�lill�����1lll�ll��l�l��fII�IIII�IIIIII�I�IIIi�Pll�lli�lllllllllllllllllll�lil�lllll <br /> SWEEPS # COMP # LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK #/CASH RCVD BY DATE RECEIVED PERMIT # <br /> ................__........._.._.-.__........................................_.._.._ ____ <br /> �IIIi��I�I�IIII��� [�f�''I�II��9fI�IC�I�!lillllll1�111� 111I�7��i�fllllr�l�l�llll l��il�l(II�I�I�IfI�I��I��IIII �!�1II�1l�II�IIIIiII��lll�l! II�IiII�I�Ii�IllEl��,t�llll�l<I 11�111�1�1���111, I�I�III�III�I�IH�Cl�ifl�illl�llll �I�I!���II�1�1�1111�IIIl�l��il�lls <br />