Laserfiche WebLink
SAN JOAQUI�UNTY PUBLIC HEALTH SERVICES-ENVIR NTAL HEALTH DIVISION <br />UNDER ROUND STORAGE TANK PROGRA F -EE WORKSHEET <br />rpt, I ry c rrtt11u I r <br />FACILITY NAME <br />FACILITY CONTACT NAME <br />rJA <br />2000 <br />2001 <br />4f4CILITY <br />AD RESS <br />SITE PHONE # WITH AREA CODE <br />C/ <br />;c� ��) J �. <br />�9 — 3 <br />)ADDRE <br />STATE <br />ZIP CODE <br /># OF TANKS AT SITE <br />,(CITY <br />�n <br />'►� le <br />' l l <br />A <br />CA <br />ZIP CODE <br />rpt, I ry c rrtt11u I r <br />APPLICANT BILLING NAME <br />APPLICANT C NTACT NAME <br />rJA <br />2000 <br />2001 <br />TEMPORARY CLOSURE FEE = $261 / FACILITY <br />k / <br />Cc::j <br />fi <br />P L L J <br />PIPING REPAIR FEE = $261 / FACILITY <br />APPLIC I - --1 IINNG <br />APPLICANT PHONE # WITH AREA CODE <br />)ADDRE <br />TANK PENALTY ASSESSED <br />CITY ' <br />STATE <br />ZIP CODE <br />CIRCLE WORK TO BE DONE: <br />Closure Installation Repair Retrofit <br />klyy <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM = $10 / FACILITY <br />r i <br />rpt, I ry c rrtt11u I r <br />TANK ID # (s)_: <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK <br />$125 PER TANK AFTER FIRST TANK <br />1996-1999 <br />(S1 70) X (# tanks) X (# of years applicable) <br />2000 <br />2001 <br />TEMPORARY CLOSURE FEE = $261 / FACILITY <br />TANK RETROFIT REPAIR FEE = $261 / FACILITY <br />$ <br />PIPING REPAIR FEE = $261 / FACILITY <br />$ .94700 <br />$ <br />TANK PENALTY ASSESSED <br />$ <br />TANK SURCHARGE = $8 / TANK <br />$ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM = $10 / FACILITY <br />$ <br />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place) <br />TANK ID # (s)_: <br />CLOSURE FEE = $261 / TANK t <br /># TANKS X S261 = <br />TEMPORARY CLOSURE <br />(Plan Review and Inspections) <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = $261 / FACILITY <br />ION PLAN CHECK <br />and Construction Ir <br />TANK ID # (s) : IPLAN CHECK FEE = $696 / FACILITY <br />REPAIR PLAN CHECK <br />TANK ID # (s) : <br />$ <br />TANK LINING REPAIR FEE = $261 / TANK <br /># TANKS X $261 = <br />$ <br />TANK RETROFIT REPAIR FEE = $261 / FACILITY <br />$ <br />PIPING REPAIR FEE = $261 / FACILITY <br />$ .94700 <br />MISCELLANEOUS <br />TRANSFER FEE _ $ 20 <br />$ <br />CONSULTATION FEE = $ 87/ HOUR <br />$ <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 87 / HOUR <br />$ <br />SAMPLING INSPECTION FEE _ $ 87/ HOUR <br />Al I crcc wow <br />$ <br />... ,o, nllvm" r '=- nmc a naa tact ttUS FEES PAID WILL BE BILLED TO APPLICANT. <br />OFFICE USE ONLY <br />1 acnvn,c mcwUrzi a rs I I -A LI a r w AMOUNT RECEIVED I CHECK # FRECEIVED BY I DATE RECEIVED <br />SR <br />