Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />UNDERGROUND STORAGE TANK PROGRAM -FEE WORKSHEET <br />S FACILITY SITE NAME ` FACILITY CONTACT NAME <br />T <br />E FACILITY ADDRESS SITE PHONE # with AREA CODE <br />& <br />CITY STATE ZIP CODE # of TANKS <br />A at SITE <br />P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br />L <br />I <br />C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br />A <br />N <br />T CITY STATE ZIP CODETYPE of APPLICATION <br />(Closure, Installation, etc.) <br />TOTAL <br />AlTANK FEE = S50.00/TANK (Prior to January 1,1991) S170/TANK (After January 1, 1991) <br />V <br />T <br /># Tanks = <br />1986 1987 1988 1989 1990 <br />1991 1992 1993 1994 1995 1996 <br />I <br />(multiply W�y"fee for <br />XXXX XXXX XXXX XXXX XXXX <br />5 <br />V <br />each year applicable) <br />E <br />TANK PENALTY FEES ASSESSED <br />XXXX XXXX XXXX XXXX XXXX <br />S <br />S <br />I <br />STATE SURCHARGE = S56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 <br />T <br />E <br /># Tanks x $56.00 <br />1986 through 1990 <br />1991 through 1996 <br />(Enter amount and year) <br />CPERMANENT <br />CLOSURE (Removal or Authorized Closure-in-Ptace) <br />TANK I.D. #(s) <br />0 <br />CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) <br /># TANK(s) X 5234.00 = <br />5 <br />S <br />U <br />TEMPORARY CLOSURE (Plan Review & Inspections) <br />TANK I.D. #(s) <br />R <br />E <br />TEMPORARY CLOSURE FEE = 578.00/hour (3 hours minimum/FACILITY) <br />$234.00 minimum <br />$ <br />P <br />INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) <br />TANK I.D. #(s) <br />L <br />A <br />N <br />PLAN CHECK FEE = 578.00/hour (8 hours minimum/FACILITY) <br />= $624.00 minimum <br />$ <br />R <br />REPAIR FEE (Workplan Review & Construction Inspections) <br />TANK I.O. #(s) <br />P <br />TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) <br /># TANK(s) X $234.00 = <br />5 <br />A <br />I <br />TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) <br />= S234.00 minimum <br />$ <br />R <br />PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) <br />= S234.00 minimum <br />5 <br />M TRANSFER FEE = S20.00 <br />I <br />S -- <br />C CONSULTATION FEE = S78.00/hr <br />UNAUTHORIZED RELEASE EVALUATION = 578.00/hr S <br />SAMPLING INSPECTION FEE = S78.00/hr $ <br />TOTAL DUE <br />EH 23 046 (Revised 9/11/96) Page 11 <br />