COMPLIANCE INFO_1991-2004 - Laserfiche WebLink

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A TOTAL C 1986 1987 1988 1989 1990 T ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 I $ V E TANK FEE _ $50.00/TANK (prior to January 1,1991) $170/TANK (after January 1, 1991) F # Tanks = 3 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 A (multiply # by fee for C each year applicable) S�L) 1 L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 I T # Tanks .3 x $56.00 1986 through 1990 1991 through 1996 Y (enter amount and year) /6 $ /toe C JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION FACILITY CONTACT NAME F /CP�7 (�2T2 �JGInQviS UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET FACILITY ADDRESS (q e® w. t1 Sf_ SITE PHONE # with AREA CODE T Y A TOTAL C 1986 1987 1988 1989 1990 T ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 I $ V E TANK FEE _ $50.00/TANK (prior to January 1,1991) $170/TANK (after January 1, 1991) F # Tanks = 3 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 A (multiply # by fee for C each year applicable) S�L) 1 L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 I T # Tanks .3 x $56.00 1986 through 1990 1991 through 1996 Y (enter amount and year) /6 $ /toe C FACILITY SITE NAME FACILITY CONTACT NAME F QVv D �S I� v�C (�2T2 �JGInQviS I L I FACILITY ADDRESS (q e® w. t1 Sf_ SITE PHONE # with AREA CODE T Y CITY _^ FSTATE ZIP CODE # of TANKS # TANK(s) X $150.00 = t( GSC, � q5 37 at SITE A APPLICANT/BILLING NAME APPLICANT CONTACT NAME PP P`�� 1 T `AV111ron W; T �2�2 JQVkQYk S ,�InC. I MAILING ADDRESS �o �oc��% APPLICANT PHONE # WITH AREA CODE A O. 4tS- 84 a N T CITY STATE ZIP CODE TYPE of APP CLOSURE, NSTALLATI ', etc. --------------- A TOTAL C 1986 1987 1988 1989 1990 T ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 I $ V E TANK FEE _ $50.00/TANK (prior to January 1,1991) $170/TANK (after January 1, 1991) F # Tanks = 3 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 A (multiply # by fee for C each year applicable) S�L) 1 L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 I T # Tanks .3 x $56.00 1986 through 1990 1991 through 1996 Y (enter amount and year) /6 $ /toe 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 N U R TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. #(s) E TEMPORARY CLOSURE FEE = $150.00 each TANK # TANK(s) X $150.00 = $ P PLAN CHECK (Install. Plan Review & Construction Inspections) TANK I.D. #(s) L TANK REPAIR FEE = $53.00 per hour (3 hours minimum/TANK) # TANK(s) X $159.00 = A I N PLAN CHECK FEE - $53.00 per hour (8 hours minimum per Facility) _ $424.00 minimum 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 S C FEE = $53.00/hr T FEE = $53.00/hr FEE _ $ 53.00/hr TOTAL DUE ' $ ! ! p d2 • J D OFFICE USE ONLY EH 23 032 (REV 1/10/91) ft Pace 11