Laserfiche WebLink
SAN JOAQUIN r TY PUBLIC HEALTH SERVICES - ENVIRONMENTAL ! 'H DIVISION <br /> • UNl IOUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> S FACILITY SITE NAOEFACILITY C NTACT NAME <br /> I <br /> T 0 1 1 'bill& 60rk CtArff <br /> E FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> u Id <br /> A CITY �U STATE ZIP CODOE� atoSITENKS��� <br /> P (775^x,( <br /> P APPLICAN /BILLING NAME APPLICANT CONTAC NAME <br /> L rner C- a U'\ <br /> I <br /> CMAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> A <br /> M- <br /> T CITY ST TE ZIP COD TYPE of APPLICATION I <br /> ren (Closure, Installation, etc.) nJIQI'Q'��u/l <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) _ $100.00 <br /> A XXXX XXXX XXXX XXXX XXXX $ XXXXXXXXXXXXX <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XXXX XXXX XXXX XXXX $ XXXXXXXXXXXXX <br /> I <br /> V TANK FEE _ $50.00/TANK (Prior to January 1,1991) $170/TANK (After January 1, 1991) <br /> E <br /> # Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 �nU 3��0 6 <br /> F (multiply # by fee for <br /> A each year applicable) XXXX XXXX XXXX XXXX XXXX $ O' <br /> C <br /> I TANK PENALTY FEES ASSESSED XXXX XXXX XXXX XXXX XXXX $ <br /> L <br /> I STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 <br /> T O Od <br /> Y # Tanks $56.00 1988 through 1990 1991 through 1996 �a 3 DOS <br /> (Enter amount and year) <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> L <br /> 0 CLOSURE FEE = $78.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = $ <br /> S <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = $78.00/hour (3 hours minimum/FACILITY) $234.00 minimum $ <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = $78.00/hour (8 hours minimum/FACILITY) _ $624.00 minimum $Q �O <br /> R REPAIR FEE (Workplan Review & Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE = $78.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = $ <br /> A <br /> I TANK RETROFIT REPAIR FEE = $78.00/hour (3 hours min./FACILITY) = $234.00 minimum $ <br /> R <br /> PIPING REPAIR FEE _ $78.00/hour (3 hours minimum/FACILITY) = $234.00 minimum $ <br /> M TRANSFER FEE _ $20.00 UNAUTHORIZED RELEASE EVALUATION = $78.00/hr $ <br /> I <br /> S <br /> C CONSULTATION FEE _ $78.00/hr SAMPLING INSPECTION FEE = $78.00/hr $ <br /> TOTAL DUE $167K. 0 <br /> FOR OFFICE USE ONLY <br /> :::::::............................... :....................................._....................................................... .............._........._......................................__._.. <br /> :st:c<::::_::s::::::::s¢::: t:::::a::::::::::::t::::s::::::1st::::_::::¢:s¢:::s:::::::s::::::s a:::ss:::::::::::::::s......s:::: i............................................ . .......................................... <br /> SWEEPS # COMPUTER # LOC CODE DIST CODE I AMOUNT RECEIVED CHECK #/CASH RECEIVED BY DATE RECEIVED <br /> 9 <br />