COMPLIANCE INFO_1984-1994 - Laserfiche WebLink

Home Browse Search

I SAN JOAQUIN PUBLIC HEALTH SERVICES - ENVIRONMENTAL AU011�D L faX Ant STORAGE TANK PROGRAM - FEE WORKSHEET o d 8752 O U 07 S FACILITY SITE NAME FACILITY CONC E X I .Q T E FACILITY ADDRESS SITE PHONE # 3LlF� CODE CITY STATE ZIP CODE # �( A C \1 -NC Z,�, at I P P APPLICANT/BILLING NAME APPLICANT CONTACT NAME L I C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE N ` lLf T CITY STATE ZIP CODE TYPE of APPLICATI ". I I Closu Installation etc.) TOTAL 1986 1987 1988 1989 1990 ANNUAL FACILITY FEE (Prior to January 1, 1991) _ $100.00 A XXXX XXXX S C T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XXXX f I V TANK FEE _ $50.00/TANK (Prior to January 1,1991) $170/TANK (After January 1, 1991) E # Tanks = 1986 1987 1988 1989 1990 1991 1992 JM _1994 1995 1996 _..__.,. F (multiply # by fee for A each year applicable) XXXX XXXX $ 1 C I TANK PENALTY FEES ASSESSED XXXX XXXX - $ L I STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 T Y # Tanks�� x $56.00 1988 through 1990 1991 through 1996 J (Enter amount and year) C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) L 0 CLOSURE FEE = $78.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = f S 3g� U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) R E TEMPORARY CLOSURE FEE = $78.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = f P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) L A N PLAN CHECK FEE = $78.00/hour (8 hours minimum/FACILITY) _ $624.00 minimum R REPAIR FEE (Workplan Review & Construction Inspections) TANK I.D. #(s) E P TANK LINING REPAIR FEE = $78.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = S A I TANK RETROFIT REPAIR FEE = $78.00/hour (3 hours min./FACILITY) = $234.00 minimum $ R PIPING REPAIR FEE _ $78.00/hour (3 hours minimum/FACILITY) = $234.00 minimum f M TRANSFER FEE = $20.00 UNAUTHORIZED RELEASE EVALUATION = $78.00/hr f I S C CONSULTATION FEE _ $78.00/hr SAMPLING INSPECTION FEE = $78.00/hr $ TOTAL FbR OFFICE USE ONLY r.....r.......:._:.:..�....:..t..s..»......e..:..w.........-......»:..:..:..:..:..:..:..�....:..:..:..:..:..n..e.»...»...:.�.:.:.:.............. .._•a.:.:f.:»».«..a..^.......^.«..:.:.:.•s...ra...:..:...«••....:..:r.r:.:.—...«:.:._.:.:_r._.»...».._::;.r.._........»..«....«s..«.... .............._..i..».-..»..rr..s.:».•..•»,as«s»:..:.e:s:..^...;.^:.:.•:T.»._9:.i:.r..�-2.'.. r..»...r..:«s•.•.•«h :•6,:...�.............:.:..�....•.s»i»..c..«=._'_;:..:«»:.:.r:..:.:..s:.::.:.»..a.:.r:..:..:.'-:.c.:.:e.e:.:».:....x....a..»_..:.:.:. »::..n_..?.e.?.�..:er^..„.'_ =..•.;r. �::; . ...... »M ..................................... :.....::::.......:::K.._=:..rxx. . SWEEPS # COMPUTER # LOC CODE DIST CODE AMOUNT RECEIVE CHECK /CASH RECEIVED BY DATE RECEIVED r s ..:.ss............sr...... ............. ......................._..... ........._::..............._................. ........»«..........................«...............«..._«.»««..............._..............................................._.........;..;..;.;.. ....................... ................._........................ .... ...........•...........«.«.. ...,«.s..:..-s............:c::s:sx.......,:..«..:•c::..:.........»..........«..s......:....:......................ss£...s...:.. .................:........... d.s.......•�'s._?s�...:...._s...r............................. .«...:.....«..........«..................s:: „...:•if:s:::::.;.;.,..y..•s:ss........«...«...:::s. .......••......«.. ....... .........._................«....«..«s:• EH 23 032 (REVISED 6-21-93) Page 11