Laserfiche WebLink
JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNOERGRCUND STORAGE TANK PROGRAM - FEE WCRKSHEET <br /> d <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> ACl ; F,R 4 2��1 D <br /> [ FACILITY ADDRESS� / �� SITE PHONE # with AREA qI — 0 E a 3 S_ <br /> IL C� <br /> T CITY <br /> STATE ZIP COE # of TANKS v . <br /> Y -/ Gl� � at SITE �f <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> L 'e <br /> I MAILING A00 E / APPLICANT PHONE X WITH AREA OOE <br /> A <br /> N CITY i STATE ZIP CODE TYPE of APPLICATION <br /> TC �� CLOSURE, INSTALLATION, etc./,j, <br /> TOTAL <br /> A <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br /> I i S <br /> V <br /> E TANK FEE = S50.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F # Tanks = 1986 1987 1988 19891990 1991 1992 1993 1994 1995 1996 <br /> A (multiply # by fee for <br /> C each year applicable) S <br /> I I --- --I I <br /> L STATE SURCHARGE = 356.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 <br /> I <br /> T # Tanks x 556.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) <br /> $ <br /> P URE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) l DCS/ <br /> L CLOSURE FEE - S53.0_0 ped hour (3 h . rs minimum per ? # TANK(s) X 5159.00 <br /> 0 `•� <br /> S <br /> U TEMPCRARY CLOSURE (A one-time permit, for review/inspections) TANK I.O. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = S150.00 each TANK # TANK(s) X S150.00 <br /> P PLAN CHECK (Install. Plan Review 3 Construction Inspections) TANK I.D. #(s) <br /> L JAN d 1992 <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minimum per Facility) _ $424.00 minimum <br /> R REPAIR FEE (workplan review 8 construction inspections) TANK I.D. #(s) ENVIRONM <br /> E <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimum/TANK) # TANK(s) X S159.00 = S <br /> A <br /> PIPING REPAIR FEE = 53.00 per hour (3 hour minimum per facility = S159.00) <br /> M TRANSFER FEE = $20.00 UNAUTHORIZED RELE'AS'E EVALUATION = S53.00/hr 3 <br /> I <br /> S <br /> C CCNSULTATICN FEE = 353.00/hr SAMPLING INSPECTION FEE = 353.00/hr S <br /> TOTAL DUE 3 Zff, C7 <br /> OFFICE USE ONLY <br /> ................................................................................................................................................................................................................................................................ <br /> •F.v:Wo::vo v;w viae u:s wNe:oes eve.arcs has tunror:aas a»�.+;a»�vaw:av>rw:aw:o:eeo w»»xaa;r..roe aa;xv 1:Ia»;>v::Pa:s::w:uaae:oas a»»a-.w:ws wnus NlJ swe�xas bxas xeo xa veKo wee xene»o�:eeae xas ax.+as xea roes fuenw xe�»e� <br /> 22•:r:':�:sii;.... .;;i.,....i•.:S:ii%:;:;::•i::'2:::;'y"%23�:h`�•;`.<^•L:^•ti•`icSS'.�::ir...V :<•?�^iic::::G•Y^.:•.:....;y:::...::.r.:,»:...: .,eyr�o-;.y.. <br /> "251tc-?S CCM (1ie7"R I LOC C t7'c DIST' CGJ �iCliNY �Cbi) <br /> x <br /> 0 <br /> 0 <br /> ....e......... ..... ........................ ......n............ ....�'.. �. .... .��. ................ o.� __. <br /> :ao:tu:a.u:exee.0»ee:ese;eeeoe was waswoaes wa�wx»»eo:cee»:a»axrcs:.w»». :eeeeo:oai::v'ieee»»»»•a waa:weea:ees awses Iasi u»si "zos iae»ew»ieeiel " »»iee:iea iee's weeewiaeal•"»ve»-•'u:� 'X?771 A?i•� .'CYK.GY <br /> ..:.'.::K::..226:tOF::.tai':.A'.:�.X6:Y'K«`".x::.kVf:GCb:'^w:.:1;::5::..:.6i�:::•3.:^6:YJf:: •�&:b;�l �:f«'C.xt' `"'�."b:GbJ.:f <br /> EH 23 032 (REV 4;8/91) ft ` Pace 11 <br />