Laserfiche WebLink
SAN JOAQUIN COUXTftPLIC HEALTH SERVICES - ENVIRONMENTAL HEALTHWWVSION <br /> UNDEAjW0 STORAGE TANK PROGRAM - FEE WORKSHEET qP <br /> S) FACILITY SITE NAME FACILITY CONTACT NAME <br /> TL - `a(C� 0� <br /> El FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> P CITYr1 /� IE ZIP CODE # ®f TANKSCX <br /> V C'E-- o� at SITE L.-L`=iY <br /> PAPPLICANT/BILLING NAME APPLICANT CONTACT NAM <br /> L C Cc-E 1, <br /> C MAILING ADDRESS �� APPLICANT ONE # WITH AREA CODE <br /> M U �- CbLk�; S �4 I :� '510 <br /> T CITY STATE ZIP CODE T E of APPLI <br /> 94-59 (Closur Installation-etc.) <br /> TOTAL <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 1986 1987 1988 1989 1990 <br /> A XXXX )0= $ <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XXXX ( S <br /> I <br /> V TANK FEE _ $50.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> # Tanks = 1986 1987 1988 1989 1990 1991 ( 1992 1993 1994 11995 11996 <br /> F (multiply # by fee for <br /> A each year applicable) XXXX XXXX <br /> C ;>< S <br /> I TANK PENALTY FEES ASSESSED XXXX )0= I I I I S <br /> L <br /> I STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 <br /> T <br /> Y # Tanks -2, x 556.00 19 8 through 1990 1991 through 1996 <br /> (Enter amount and year) <br /> C PERMANENT CLOSURE (Removal or Authorizer Ctosure-in-Place) I TANK I.O. #(s) <br /> L <br /> 0 CLOSURE FEE = 578.00/hour (3 hours mininum/TANK) # TANK(s) X $234.00 = S <br /> S <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = 578.00/hour (3 ')ours minimum/FACILITY) 5234.00 minimum S <br /> PI INSTALLATION PLAN CHECK (Plan Review & :.�struction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = 578.00/hour (8 hours minimum/FACILITY) = 5624.00 minimum S <br /> Rf REPAIR FEE (Workplan Review & Construction Inspections) I TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) TANK(s) X 5234.00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE = 578.00/hour 1,3 hours min./FACILITY) = 3234.00 minimum S <br /> R <br /> PIPING REPAIR FES = 578.00/hour (3 hours minimun/FACILITY) = 5234.00 minimum S <br /> M TRANSFER FEE = $20.00 , I UNAUTHORIZED RELEASE EVALUATION = 578.00/hr I S <br /> 1 <br /> S <br /> C CONSULTATION FEE = 578.00/hr I ` SAMPI ING INSPECTION FEE = 378.00/hr S <br /> TOTAL DUE S <br /> FOR OFFICE USE ONLY Tnt <br /> SWEEPS # ( COMPUTER # LOC CODE I DIST CODE ( AMOUNT RECEIVED CHECK 9/CASH RECEIVED BY I DATE RECEIVED <br /> 5 <br /> E4 23 032 (REVISED 10-28-93) <br />