Laserfiche WebLink
• SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES-ENVIRONMENT IEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> FACILITY NAME FACILITY CONTACT NAME <br /> .!SAFCWAY 5Togt�_: -39!�- 06C 1D <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> r 7 w86r (I Tit sTREEl- <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> y CA 155376 3.72-7 z;, 71 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> _ CC77—t c/yvS F_j4L_ '��(CSI 6�ac ? (W_ <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE: <br /> ASS-17N 1( 7 7� '' Closur InstalfaGon epair Retrofit <br /> ACTIVE FACILITY <br /> 1996-1999 2000 1 2001 <br /> $500 FEE INCLUDES FACILITY FEE+ 1 TANK ($170)X(#tanks)X(#of years applicable) <br /> $125 PER TANK AFTER FIRST TANKS $ <br /> $ G <br /> TANK PENALTY ASSESSED <br /> TANK SURCHARGE=$8/TANK $ t6. C& <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY INA CUPA PROGRAM=$10/FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID#(s): CLOSURE FEE=$267/TANK #TANKS X$267= <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections <br /> TANK ID#(s): TEMPORARY CLOSURE FEE=$267 1 FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> TANK ID#(s): PLAN CHECK FEE_$712/FACILITY $ It <br /> REPAIR PLAN CHECK <br /> TANK ID# s : <br /> $ <br /> TANK LINING REPAIR FEE =$267/TANK #TANKS X$267= <br /> TANK RETROFIT REPAIR FEE =$267/FACILITY <br /> $ <br /> PIPING REPAIR FEE _$267/FACILITY <br /> MISCELLANEOUS <br /> $ <br /> TRANSFER FEE _ $20 <br /> CONSULTATION FEE _ $89/HOUR <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $891 HOUR <br /> SAMPLING INSPECTION FEE = $89/HOUR Is <br /> ALL FEES ARE BASED ON THE$89 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST p FACILITY ID AMOUNT RECEIVED I CHECK# I RECEIVED BY I DATE RECEIVED <br /> i <br /> SR <br /> EH 23 032(REVISED 8-1-01) <br />