Laserfiche WebLink
SAN JOAOUIN C0& PUBLIC HEALTH SERVICES - ENVIRONMENTAL HE� DIVSION <br />UNMWOUND STORAGE TANK PROGRAM - FEE WORKSHEET <br />P APP CANT/BILLING NAME ,, <br />I APPLICANT PHONE # WITH AREA CODE <br />C MAILING ADDRESS ,a <br />N <br />CITY STATE P�o.�A <br />ZIP CODE tYPPLICATtON <br />JjTL, 2 �,' Closures Installation, etc.) <br />TnTAI <br />FACILITY SITE NAME <br />FACILITY CONTACT NAME <br />S <br />T <br />E <br />FACILITY ADDRESS <br />PHONE # with AREA CODE <br />A <br />XXXX I XXXX i XXXX <br />A <br />CITY STATE ZIP CODE # of TANKS f <br />J�CJI'/."lii,ti� Ci at SITE/ <br />P <br />APPLICANT CONTACT NAME <br />P APP CANT/BILLING NAME ,, <br />I APPLICANT PHONE # WITH AREA CODE <br />C MAILING ADDRESS ,a <br />N <br />CITY STATE P�o.�A <br />ZIP CODE tYPPLICATtON <br />JjTL, 2 �,' Closures Installation, etc.) <br />TnTAI <br />FOR OFFICE USE ONLY <br />SWEEPS # I COMPUTER # <br />EH 23 032 (REVISED 1-12-98) <br />LOC CODE I DIST CODE I AMOUNT RECEIVED I CHECK */CASH I RECEIVED BY ' DATE RECEIVED <br />I S 1 ... __.......... <br />�..�-..,W.._ _� _.._... <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 <br />1986 1987 11988 <br />1989 <br />1990 <br />A <br />XXXX I XXXX i XXXX <br />XXXX <br />XXXX <br />S <br />XXXXXXXX <br />CI <br />T <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />XXXX <br />%XXX XXXX <br />XXXX <br />XXXX <br />S <br />XXXXXXXX <br />II <br />V <br />TANK FEE = 550.00/TANK (Prior to January 1,1991) <br />5170/TANK (After January 1, 1991) <br />E <br />F <br />A <br /># Tanks = <br />(multiply # by fee for <br />each year applicable) <br />1988 <br />1989 1990 11991 11992 <br />1993 <br />1994 <br />1995 11996 <br />1997 <br />1998 <br />XXXX <br />XXXX I XXXX I XXXX (XXXX <br />S <br />CI <br />I <br />TANK PENALTY FEES ASSESSED <br />XXXX <br />XXXX XXXX I XXXX IXX%X <br />I <br />S <br />L <br />I <br />STATE SURCHARGE FOR NEW FACILITIES ONLY=518.50 <br />S <br />T <br />T <br /># Tanks x 58.00 <br />SURCHARGE FOR 1998 <br />1988 through 1993 (S56) <br />1993 through 1997 (S56) <br />1998 <br />XXXXXXXXXXXXXXXXXXXXXXXXXXX <br />XXXXXXXXXXXXXXXXXXXXXXX <br />S <br />C <br />PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) <br />TANK I.D. #(s) <br />L= <br />0 <br />CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) <br /># TANK(s) X S234.00 <br />I)� <br />S <br />(> Lj <br />S <br />U <br />TEMPORARY CLOSURE (Plan Review 8 Inspections) <br />ITANK I.D. #(s) <br />R <br />E <br />TEMPORARY CLOSURE FEE = 578.00/hour (3 hours minimum/FACILITY) <br />5234.00 minimum <br />S <br />P <br />INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br />L <br />A <br />N <br />PLAN CHECK FEE = 578.00/hour (8 hours minimum/FACILITY) <br />= 5624.00 minimum <br />S <br />R <br />REPAIR FEE (Workplan Review & Construction -Inspections) <br />I TANK I.D. #(s) <br />E <br />P <br />TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) <br />I �# TANK(s) X 5234.00 = <br />S <br />I <br />TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min/FACILITY) = 5234.00 minimum <br />S j �3k <br />R <br />PIPING REPAIR FEE = 578.00/hour (3 hours minima /FACILITY) <br />= $234.00 minimum <br />S <br />M <br />TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION = 578.00/hr I <br />S <br />I <br />S <br />C <br />CONSULTATION FEE = 578.00/hr I SAMPLING INSPECTION FEE <br />= 578.00/hr <br />g <br />TOTAL DUE <br />S"/, <br />FOR OFFICE USE ONLY <br />SWEEPS # I COMPUTER # <br />EH 23 032 (REVISED 1-12-98) <br />LOC CODE I DIST CODE I AMOUNT RECEIVED I CHECK */CASH I RECEIVED BY ' DATE RECEIVED <br />I S 1 ... __.......... <br />�..�-..,W.._ _� _.._... <br />