COMPLIANCE INFO_1991-2004 - Laserfiche WebLink

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vmu�J. y. ti. s Mrtt a� AOUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION' UNDERGROUND STORAGE TANK PROGRAM - FEE 1rORKSHEET PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) TANK I.D. 0(s) C L CLOSURE FEE = $53.00 per hour (3 hours minimum per TANK) " TANK(s) X $159.00 = S 0 S U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. ':(s) R E TEMPORARY CLOSURE FEE = S150.00 each TANK TANK(s) X $150.00 = S P PLAN CHECK (Install. -Plan Review & Construction Inspections) L A N PLAN CHECK FEE - $53.00 per hour (8 hours minirL n per Facility) = S424.00 minim -n R E FACILITY SITE NAME TOTAL TANK REPAIR FEE = $53.00 per hour (3 hours minimum/TANK) TANK(s) X $159.00 = S 1 FACILITY CONTACT NAME F/ A C o-V"'Dh L/\.D L NC. E�2t- Tot-,aV 1986 1987 1988 1989 1 1990 T i FACILITY ADDRESS SITE PHONE v with AREA CODE S I T CITY �_ STATE 111P CCOE `1S # of TANKS Y i('GL G E C_4 37civ at SITE A APPLICANT/BILLING NAME 1986 1987 1988 1989 APPLICANT CONTACT NAME � rx P cAellr0rj 1993 1994 1995 1 1996 I S L each year applicable) L STATE SURCHARGE = S56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 I T Y I MAILING ADDRESS 1991 through 1996 Qp�,� pu i6$ �°`° $ 2Z• APPLICANT PHONE R WITH AREA CODE A N 7 CITY �C't,v� �aw�ors STATE C 21P CODE TYPE of AAP - ��s83 CLOSURE, NSTALLATI , etc. PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) TANK I.D. 0(s) C L CLOSURE FEE = $53.00 per hour (3 hours minimum per TANK) " TANK(s) X $159.00 = S 0 S U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. ':(s) R E TEMPORARY CLOSURE FEE = S150.00 each TANK TANK(s) X $150.00 = S P PLAN CHECK (Install. -Plan Review & Construction Inspections) L A N PLAN CHECK FEE - $53.00 per hour (8 hours minirL n per Facility) = S424.00 minim -n R E REPAIR FEE (workplan review & construction inspections) TANK I.D. #(s) TOTAL TANK REPAIR FEE = $53.00 per hour (3 hours minimum/TANK) TANK(s) X $159.00 = S 1 A PIPING REPAIR FEE = $53.00 per hour (3 hour minimum per facility = S159.00) S C 1986 1987 1988 1989 1 1990 T ANNUAL FACILITY FEE (Prior to January 1, 1991) = S100.00 S I V E TANK FEE = S50.00/TANK (prior to January 1,1991) 5170/7ANK (after January 1, 1991) F A # Tanks = J Owltiply y by fee for 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1 1996 I S C I each year applicable) L STATE SURCHARGE = S56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 I T Y Tanks �✓ x $56.00 (enter amount and year) 1986 through 1990 1991 through 1996 Qp�,� pu i6$ �°`° $ 2Z• PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) TANK I.D. 0(s) C L CLOSURE FEE = $53.00 per hour (3 hours minimum per TANK) " TANK(s) X $159.00 = S 0 S U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. ':(s) R E TEMPORARY CLOSURE FEE = S150.00 each TANK TANK(s) X $150.00 = S P PLAN CHECK (Install. -Plan Review & Construction Inspections) L A N PLAN CHECK FEE - $53.00 per hour (8 hours minirL n per Facility) = S424.00 minim -n 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 = S 1 ;R PIPING REPAIR FEE = $53.00 per hour (3 hour minimum per facility = S159.00) S M CONSULTATIONS I S C FEE = 553.00/hr OFFICE USE ONLY UNAUTHORIZED RELEASE EVALUATION I SAMPLING INSPECTION FEE = S53.00/hr FEE = S 53.00/hr TOTAL DUE Is H 23 032 (REV 1/10/911 ft Pace 11