Laserfiche WebLink
SAN JOAOUIN ITY PUBLIC HEALTH SERVICES - ENVIRONMENTAL -TH DIMON <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE UORKSHEtj <br /> S FACILITY SITE NAME FACILITY C T NAME <br /> I <br /> T <br /> -E FACILITY ADDRESS SITE PHONE 0 with AREA CODE <br /> 8 <br /> CITY S P CODE of TANKS <br /> a <br /> A at SITE <br /> P <br /> P APPLICANT/BILLING AME apDl (CANT CT NAME <br /> L \ <br /> I <br /> C MAILING ADOR S AP [CANT PHONE 4 UI H AREA CODE <br /> A �� <br /> N <br /> T STATE P COD" PPL[CAT ION <br /> O (CLos , Installation, etc.) <br /> TOTAL <br /> 1986 1487 11988 11989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br /> A XXXX XXXX XXXX XXXX XXXX S XXXXXXXX <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XXXX I XXXX XXXX XXXX S XXXXXXXX <br /> I <br /> V TANK FEE = S50.00/TANK (Prior to January 1,1991) $170/TANK (After January 1, 1991) <br /> E <br /> Tanks = 1988 1989 1990 1991 11992 1993 11994 f 1995 1996 1997 1998 <br /> F (mu(tiply # by fee for <br /> A each year applicable) XXXX XXXX I XXXX XXXX XXXX S <br /> C <br /> I TANK PENALTY FEES ASSESSED I XXXX XXXX XXXX I XXXX (XXXX I S <br /> L <br /> I STATE SURCHARGE FOR NEW FACILITIES ONLY=518.50 $ <br /> T f <br /> Y Tanks x 38.00 1988 through 1993 (S56) 1993 through 1997 ($56)T1998 <br /> + <br /> SURCHARGE FOR 1998 XXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXX S <br /> C PERMANENT CLOSURE (Removal or Authorized CLosure-in-Place) I TANK I.D. x(s) <br /> 01 CLOSURE FEE = $78.00/hour (3 hours minimum/TANK) I 9 TANK(s) X 5234.00 = S <br /> S' <br /> U TEMPORARY CLOSURE (Plan Review 3 Inspections) TANK 1.0. ;*(s) <br /> R <br /> El TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/FACILITY) 5234.00 minimum S <br /> PI INSTALLATION PLAN CHECK (PLan Review & Construction Inspections)I TANK I.D. l(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = S78.00/hour (3 hours minimum/FACILITY) = S624.00 minimum VS <br /> R REPAIR FEE (Workplan Review 3 Construction Inspections) I TANK I.D. x(s) <br /> E /\ <br /> P TANK LINING REPAIR FEE = S78.00/hour (3 hours minimum/TANK) X TANK(s) X 5234.00 = S ,OV <br /> A <br /> I TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = $234.00 minimum S <br /> R <br /> PIPING REPAIR FEE = S78.00/hour (3 hours minimum/FACILITY) = $Z34.00 minimum S <br /> M TRANSFER FEE = S20.00 i UNAUTHORIZED RELEASE EVALUATION = S78.00/hr I S <br /> I 1 <br /> S <br /> C CONSULTATION FEE = S78.00/hr I I SAMPLING INSPECTION FEE = $78.00/hr I S <br /> TOTAL DUE S 3y <br /> FOR OFFICE USE ONLY —••• <br /> it':€ `: ...............'`................. .....................................:_ ............... :[:::-:s::—_:_-__::::_s:::_:_: :s::::::;_::-:_s--::::::•_ ::_•�::: <br /> _.._...._..............---..._..._.:_........_._..-----.._..----.................—........__......—..:-—....._._ <br /> ....._. .. i <br /> SWEEPS COMPUTER LOC CODE DIST CODE I AMOUNT RECEIVED 1 CHECK #/CASH I RECEIVED 3Y I DATE RECEIVED <br /> 5 <br /> :a:........................................i.........................._.......... ..........__._........_._..........._............-.__-..::::-...._._....__.._.._..._.... -------__..._..---._..._ _..._.__._....__.... _ --..._ _---._ ....._.. <br /> .....................................................................................................................................:.:..:-:..,,...__._..,.............._.....................,....::::•::.............,..,.. <br /> ..............:......................................................................................_. <br /> .................... . <br /> ........................ . <br /> CW ;)'� n7, (aFvrsFO 1-12-98) <br />