COMPLIANCE INFO_1991-2004 - Laserfiche WebLink

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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET A FACILITY SITE NAME FACILITY CONTACT NAME F CLOSURE FEE = $53.00 per hour (3 hours minimum per TANK) # TANK(s) X $159.00 = $ IFACILITY ADDRESS (r SITE PHONE # with AREA CODE T Y CITYSTATE l('Li GL C ZIcP]CODE (5 7 # of TANKS at SITE Aft A APPLICANT/BILLING NAME APPLICANT CONTACT NAME P P L pp -�— �.Vl��fvh U &C.. t --T- t �Q_Te �JCk\'Nay91�40 � - ,; I MAILING ADDRESS 7 / APPLICANT PHONE # WITH AREA Q $ E TANK FEE = 550.00/TANK N T CITY STATE JZIP C� CODE TYPE of APP £Ae� �R I CLOSURE, T'_ LAI , etc. A PERMANENT CLOSURE (Removal or Authorized Ctosure-in-Place) TANK I.D. #(s) L 0 CLOSURE FEE = $53.00 per hour (3 hours minimum per TANK) # TANK(s) X $159.00 = $ S TOTAL C T I V ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 E 1986 1987 1988 1989 1990 FEE = 553.00/hr FEE = 5 53.00/hr $ E TANK FEE = 550.00/TANK (prior to January 1,1991) $170/TANK (after January 1, 1991) F A C I # Tanks = (multiply # by fee for each year applicable) 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 ) O $ cJ-1 c) L I STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 T Y # Tanks 3 x $56.00 (enter amount and year) 1986 through 1990 1991 through 1996 C PERMANENT CLOSURE (Removal or Authorized Ctosure-in-Place) TANK I.D. #(s) L 0 CLOSURE FEE = $53.00 per hour (3 hours minimum per TANK) # TANK(s) X $159.00 = $ S R U R TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. #(s) E TEMPORARY CLOSURE FEE = 5150.00 each TANK # TANK(s) X $150.00 = $ PPLAN CHECK (Install. Plan Review & Construction Inspections) TANK I.D. #(s) (�� '3 L $ I A R PIPING REPAIR FEE = $53.00 per hour (3 hour minimus per facility = $159.00) N PLAN CHECK FEE - $53.00 per hour (8 hours minimum per Facility) = $424.00 minimum woo weoeowoe wosw ww R E REPAIR FEE (workplan review & construction inspections) TANK I.D. #(s) P A TANK REPAIR FEE = $53.00 per hour (3 hours minimum/TANK) # TANK(s) X $159.00 = $ I R PIPING REPAIR FEE = $53.00 per hour (3 hour minimus per facility = $159.00) $ M CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION I e aao �w ww woo mroa exro wow woe woo waw woe>awoo S woo weoeowoe wosw ww 011 wo�oo •••. • n (L •••.......•.•••.........• C FEE = $53.00/hr FEE = 553.00/hr FEE = 5 53.00/hr TOTAL DUE 5 OFFICE USE ONLY ................................................................................................................................................................................................................................................................ ww>.w � woo »aow xao wanoo woo woo raooa was a000eo weewaoro owo>waae woo woo mxe woe a0000e w0000wae wee was wwoo woe waooe woo w0000 waeweem mems,�,s,�.,,wV,...,.,.,,.�.,,..................._.-. •--. •----- ---- ------ ---- ----- -- - w .........wooaao>........ woaae woewowe woo:weoomewmewwaewaewwao waowaaoewoowoowaaee woe wwoe woo wwee woe wewowao woo woo EH 23 032 (REV 1/10/91) ftgo Paoe 11 �0h�pIPT2°gar®C`�Ct7 e aao �w ww woo mroa exro wow woe woo waw woe>awoo woo ooaaao w»wc-:oewoe woo weoeowoe wosw ww 011 wo�oo •••. • n (L •••.......•.•••.........• a ....�...• •.. .... � w .........wooaao>........ woaae woewowe woo:weoomewmewwaewaewwao waowaaoewoowoowaaee woe wwoe woo wwee woe wewowao woo woo EH 23 032 (REV 1/10/91) ftgo Paoe 11