Laserfiche WebLink
SAN JOAOUINY PUBLIC HEALTH SERVICES - ENVIRONMENTA TH DIVSION <br /> &GROUND STORAGE TANK PROGRAM - FEE WORKSH <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> T Lk L.A�. sr, e -�- 5rr� tV <br /> E FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> E. <br /> Czo�' a8z- 7s <br /> CITY SST,AATE ZIP CODE # of TANKS <br /> P �—'1 at SITE 4 <br /> P ;-?LICANT/BILLING NAME APPLICANT CONTACT NAME <br /> I L —RT 3l�IFR <br /> C kAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> N �El� D i� 7 A46- <br /> T CITY STATE ZIP CODE TYPE of APPLICATION 8 1j.3`r's <br /> �'J-(0g7 (Closure, Installation, etc. ,G1051ARE: <br /> TOTAL <br /> AI:NU-:. FACILITY FEE (Prior to January 1, 1991) = $100.00 1986 1987 1988 1989 1 1990 <br /> A XXXX XXXX XXXX XXXX XXXX S XXXXXXXX <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XXXX XXXX XXXX XXXX S XXXXXXXX <br /> I <br /> V ":NK FEE = S50.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> # Tanks 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 <br /> F (multiply # by fee for <br /> C each year appticabte) XXXX XXXX XXXX XXXX XXXX S $' <br /> I TANK PENALTY FEES ASSESSED XXXX XXXX XXXX XXXX XXXX S �, <br /> L <br /> TSTATE SURCHARGE FOR NEW FACILITIES ONLY=$18.50 S <br /> - j <br /> Y # Tank;_.. X S8.00 1988 through 1993 ($56) 1993 through 1997 ($56) 1998 <br /> SURCHARGE FOR 1998 XXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXX S <br /> C Pz-RMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> L <br /> 0 CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) # TANK(s)__7 — X 5234.00 = S <br /> S <br /> U TEMPORARY CLOSURE (Plan Review b Inspections) TANK I.D. #(s) 59 Z.Q <br /> R <br /> E TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/FACILITY) 5234.00 minimum S <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = S78.00/hour (8 hours minimum/FACILITY) = 5624.00 minimum S <br /> R REPAIR FEE (Workplan Review & Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE = S78.00/hour (3 hours minimum/TANK) # TANK(s) X S234.00 = S -�- <br /> A <br /> RI TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = $234.00 minimum S <br /> PIPING REPAIR FEE = S78.00/hour (3 hours minimum/FACILITY) = $234.00 minimum S <br /> M TRANSFER FEE = S20.00 UNAUTHORIZED RELEASE EVALUATION = S78.00/hr S <br /> i <br /> S <br /> C CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE = S78.00/hr S <br /> OFFICE USE ONLY TOTAL DUE <br /> S <br /> h... .£F.£:ii??££££i?gP£^?f«re�nmte,_,,es�m.. .«...»».«...«.... .. .....». .. ae•rrn•r� e <br /> ueuu:uuuuJ£G:f3Gut£a£fimGii££iii6£iF£iuhui££tl:u££ MUM <br /> ••.• ••• .•.••. ••••••••:st£.r rs:_.:::_.r.:-.•-_ ._•:•: £i£::'..-_'.... <br /> .....t«»ss ...._..» »......»» ... .««............................»»......... �Sti�^:w'tt•T...::tnS.T.�ti:.� .. ....RtSSiii!!ltC:IItl:::!'ttr.:q <br /> ii£GuiGt-e:•££i£wiuus+ouu+::cic::utuute£iH£iiuiuiiii.uiuiuiL•£iiiiiiiiui:££iit£iiiiii£iiiiiFiiiuii£:s¢uiii£iiCii£i£iii[ui£»uiu:..: :::euuuuc;ui:i:£ic_::e£iwu£Gtssr�iutwui£i£££it£s:ieueuiui:m"i8iiieuu£ii£Fiuilii££iuiiiitus'm`£u£'t��N <br /> SWEEPS # COMPUTER # LOC CODE DIST CODE AMOUNT RECEIVED CHECK #/CASH RECEIVED BY DATE RECEIVED , n <br /> m q <br /> S <br /> .......................a. •.. a.!li81ll}[Sltfnil9!!T??t ...»:..._ .s a ...t: .t. »._t££££££££'.£?££Gt.«'n''t't.»:££E££££..:......2-:::i_...».:L..:.C:....:..1::..... »q•t.•.:tf"+i <br /> 'd?ii£i£i£i£££i£iiilFui££U££ii£L'i£s7xEm 'FiG7w7i£t1£f££i££iitia£taw'G3t�t..... ..........r•;r;»..... ....:». n. rs–.n:nr...;..,.r Int;:ecssii:-sr:,r;.ei�s£.r.££emmn tq <br /> uGu=ls_«.u.iv-wsL_uG.i.c..£ui.!£4ui£iu.i:_££££iii££aiG£.t£i£:Gsc_.oi££££iui£i£!i»£ir_£ei�::•. :ii»=Eii3£o?aE_'_;'•_•3$£i£ilii£i3£iiiiL£i£Eii_££ii££iii££ii�'tt..«°?£r•1.::.£n�£ii£i£i£i££=°=£a::::1 <br /> EH 23 032 (REVISED 1-12-98) <br />