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SAN JOACUIN CCUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH OIVISION <br /> •UNDERGRCUND STORAGE TANK PRCGRA14 FEE uORaT <br /> FACILITY SITE NAME ��� FACILITY CONTACT NAME <br /> F « �a / <br /> C. <br /> I FACILlTTO{)RSS _ _ f � SITE PHOt1E X With AREA CCflE <br /> I <br /> T CITY STATE ZIP CCOE X of TANKS <br /> Y at SITE + <br /> A APPLICANT/9ILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE I WITH-AREA COOS <br /> C <br /> A <br /> N CITY STATS ZIP CCOE TYPE of APPLICATION <br /> T CLOSURE, INSTALLATION, etc. <br /> TOTAL <br /> A <br /> C 1986 1987 t988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br /> 1 5 <br /> Vw <br /> E TANK FEE = 550.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F * Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1995 <br /> A (muttlply I by fee for <br /> C each year applicable) s <br /> 1 <br /> L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H S S Code, Section 25287 <br /> 1 <br /> T A Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) <br /> S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK T.D. x(s) <br /> C <br /> L CLOSURE FEE = $53.00 per hour (3 hours miniffun per TANK) ? TANK(s) X 5159.00 S <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review d inspections TANK i.D. 9(s) <br /> R <br /> E TEMPORARY CLOSURE FEE m (150.00 each TANK !! TANK(s) X $150.00 S <br /> P PLAN CHECK (Install. Plan Review b Construction Inspections) TANK J.D. N(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minimus per Facility) = $424.00 minimum S <br /> R REPAIR TANK 1.0. Y(s) <br /> E <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimuart/TANK) 0 iANK(s) X S159.00 = S <br /> A J <br /> R PiPING REPAIR REVIEW 3 CONSTRUCTION = $53.00 per hour (3 hour minimum per facility = S159.00) S <br /> M CONS T ONS 6l UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION ` 1 <br /> I <br /> S <br /> C FEE _ 153.00/hr FEE S53.00 h, FEE = 5 53.00/hr <br /> TOTAL DUE S 6 <br /> OFFICE USE ONLY <br /> ]wY1P1!/r,.r�r�sa�e.tri.rFw+.�I�.a�MO�wi.4�.N�:Mt+Sp�:ol�Jvw 4�.+:K�4%a+::1F Ufi%DPP SON':Mi hi-.C4fl. .ir 15+O0w.CtU:K]iafMK►:/;INsW W+ri 4itwa.ww�srwrsw�w�.aw www s•Y r.rrr r-w <br /> ��E�?S�"'� Yccu��" �llC'CO�}�''���ls`(�'CCOE" 's�'A�ICUIIT'RC+S)w ... C�Ecx.,�iclsii...•�[0�~13Y""� "�`d��'�t�E�"""'�iir�"i�.�'�" <br /> 16 .r-rz................._.._........... <br /> xPw:w wP�. [sd+' tt'MNa►"ff`KTT aw.'Ksw CT N.( iSw::^4:w:tt9:!' fi at r+w R+P ar y.wP rr rr r ry+�ptwP swr www r <br /> 1N 1� AW MWWW Abw =x�'x IX .3}'f yrrr tiY r,.s..w Y... .,.r x.'j.s <br /> cu TZ nil rocv t:Ff7RIon1 fr <br />