Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVSION <br />1Mnc0corrlun cTnRAGE TANK PROGRAM - FEE WORKSHEET <br />P <br />FACILITY SITE NAMEl)Jc� v��/� q ��,IE+I <br />FACILITY CONTACT NAME �.�7�_( �;A u <br />S <br />11989 <br />t`eb <br />1990 <br />T <br />'E <br />FACILITY ADDRESS i <br />SITE PHONE # with AREA CODE <br />xxxx <br />CITY j�,, f � <br />5,T.ATE <br />Z I P CODE _ <br />�/'_S <br /># of TANKS <br />at SITE <br />A <br />A <br />PIPING REPAIR FEE 578.00/hour (3 hours minimum/FACILITY) = $234.00 minimum <br />S <br />P <br />P <br />APPLICANT/BILLING NAME . <br />APPLICANT CONTACT NAME <br />L <br />c <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />I <br />C <br />MAILING ADDRESS �' <br />APPLICANT PHONE # WITH AREA COOS_ <br />,-7--e,-t '-' ` (4 (,_ -� <br />(C -- . `S f �, , <br />XXXX <br />xxxx <br />S XXXXXXXX <br />N <br />TANK FEE = 550.00/TANK (Prior to January 1,1991) <br />STATE <br />ZdP CODE <br />TYP APPLICATION <br />T <br />CITY <br />1990 <br />1991 <br />Closure Installation, etc.) <br />1993 <br />1994 <br />1995 1199b 11997 <br />1948 <br />TnTA1 <br />P <br />INSTALLATION PLAN CHECK (Plan Review & Construction Inspections)I TANK I.D. #(s) <br />1986 <br />1987 11988 <br />11989 <br />1990 <br />REPAIR FEE (Workplan Review & Construction inspections) <br />I TANK I.D. #(s) <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br />xxxx <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />S XXXXXXXX <br />A <br />PIPING REPAIR FEE 578.00/hour (3 hours minimum/FACILITY) = $234.00 minimum <br />S <br />M <br />TRANSFER FEE = S20.00 UNAUTHORIZED RELEASE EVALUATION = S78.00/hr I <br />S <br />I <br />Cxxxx <br />T <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />S <br />C <br />xxxx <br />XXXX <br />XXXX <br />xxxx <br />S XXXXXXXX <br />I5170/TANK <br />V <br />TANK FEE = 550.00/TANK (Prior to January 1,1991) <br />(After January 1, 1991) <br />E <br />1988 1989 <br />1990 <br />1991 <br />1992 <br />1993 <br />1994 <br />1995 1199b 11997 <br />1948 <br />N Tanks = <br />F <br />(multiply # by fee for <br />S <br />A <br />each year applicable) <br />XXXX XX%X <br />XXXX <br />XXXX <br />XXXX <br />I <br />C <br />I <br />TANK PENALTY FEES ASSESSED <br />XXXX XXXX <br />XXXX <br />XXXX <br />XXXX <br />S <br />L <br />I <br />STATE SURCHARGE FOR NEW FACILITIES ONLY=S18.50 <br />S <br />T <br />Y <br /># Tanks x $8.00 <br />1988 through 1993 (S56) <br />1993 through 1997 ($56) <br />1998 <br />XXXXXXXXXXXXxxxxxxxxxxxxXXX <br />XXXXXXXXXXxxxxxxxxxXXXX <br />5 <br />SURCHARGE FOR 1998 <br />C <br />PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) I TANK I.D. #(s) <br />0 <br />CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) ` # TANK(s) x 5234.00 = 5 <br />S <br />U <br />TEMPORARY CLOSURE (Plan Review & Inspections) <br />TANK I.D. #(s) <br />RS <br />E <br />TEMPORARY CLOSURE FEE = 578.00/hour (3 hours minimum/FACILITY) <br />$234.00 minimum <br />P <br />INSTALLATION PLAN CHECK (Plan Review & Construction Inspections)I TANK I.D. #(s) <br />L <br />A <br />N <br />PLAN CHECK FEE = S78.00/hour (8 hours minimum/FACILITY)_ $624.00 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 minirtum/TANK) <br /># tANK(s) X 5234.00 = <br />S <br />A <br />I <br />TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) = $234.00 minimum <br />S <br />R <br />PIPING REPAIR FEE 578.00/hour (3 hours minimum/FACILITY) = $234.00 minimum <br />S <br />M <br />TRANSFER FEE = S20.00 UNAUTHORIZED RELEASE EVALUATION = S78.00/hr I <br />S <br />I <br />i <br />S <br />C <br />CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE = 578.00/hr <br />I <br />g <br />TOTAL DUE <br />5 <br />FOR OFFICE USE ONLY <br />SWEEPS # 1 COMPUTER # LOC CODE DIST CODE I AMOUNT RECEIVED I CHECK 0/CASH I RECEIVED By I GATE RECEIVED <br />S <br />04 77 n12 (RFVISFD 1-12-98) <br />