Laserfiche WebLink
SAN JOAGUIN COUNTY PUBLIC HEALTH SERVTCES - ENVIRONMENTAL HEALTH DIVSION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> S FACILITY SITE NAME I FACILITY CONTACT NAME <br /> I AT&T <br /> T <br /> ELITY ADDRESS SITE PHONE 9 with AREA CCOE <br /> a 10 West Turner Road <br /> CITY STATE ZIP CODE 1 0 of TANKS <br /> A Lodi CA at SITE <br /> P :I <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> LKvaerner Aronson Inc. raaj:y Ma= <br /> C MAILING ADDRESS APPLICANT PHONE 0 WITH AREA CODE <br /> A 11297 Coloma Rd <br /> T CITY STATE Z I P CGDE TYPE of APPLICATION PIpzng <br /> Rancho Cordova CA 95670 (Closure, Installation, ecc.Repolr <br /> TOTAL <br /> 1985 1987 � 1988 11989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = S100 00 <br /> A XXXX XXXX XXXX XXXX I XXXX S xxxxxxXx <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) I xxxx I XXXX xxxx XXXX I XXXX 3 xxxxxxxx <br /> I <br /> Y! TANK FEE = S5O 00/TANK (Prior to January 1,7991) I 5170/TANK (After January 1, 1991) <br /> E <br /> Tanks = 1988 1989 11990 1991 11992 11993 1 1994 1995 7995 11997 11998 <br /> F (multiply d oy ree for <br /> A� each year applicante) XXXX XXXX I XXXX XXXX XXXX I j I I I I i 3 <br /> C` <br /> I TANK P£4ALTY Fa-=-S ASSESSED I Xxxx XXXX xxxx XXXX jxxxX I I f # 3 <br /> L <br /> II STATE SURCHARGE FOR 4EW FACILITIES ONLY=S18 50 3 <br /> YI ' nks x S8 00 I 1988 :hrough 1993 (35b} 1993 througn 1997 (S5 a) 1998 <br /> �SORCHARGE FOR 1998 XXXXXXXXxxxxxxxxxxxxxxxxxXx xxxxxxxxxxxxxxxxxxxxXXX S <br /> Ci PERMANE4T CLOSURE (Removal or Authorized Closure-in-Place) TANK I D 1(s) <br /> L, <br /> 01 CLOSURE FEE = 578 00/hour (3 hours minimum/TANK) 0 TANK(s) X 3234 00 = S <br /> S <br /> UI TEMPORARY CLOSURE (Plan Review & Inspections) I TANK I 0 4(s) <br /> R <br /> EI TEMPORARY CLOSURE FEE = 378.00/hour (3 hours minimum/FACILITY) I 5234 00 minimum S <br /> PI INSTALLATION PLAN CHECK (Plan Review 3 Construction Inspectlons)l TANK I 0 #(s) <br /> LI <br /> Ai <br /> NJ PLAN CHECK FEE = S78 00/hour (8 hours minimum/FACILITY) = S624 00 minimum S <br /> R1 REPAIR FEE (Workplan Review & Construction Inspections) I TANK I 0 #(s) <br /> E <br /> P TANK LINING REDAIR FEE = S78 00/hour (3 hours minimum/TANK) I TANK(s) X $234 00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE = $78 OO/hour (3 hours min /FACILITY) = S234 00 minimum S <br /> R <br /> PIPING REPAIR FEE = $78 00/hour (3 hours minimum/FACILITY) = SZ34 00 minimum 5 <br /> MI TRANSFER FEE = S20 00 1 I UNAUTHORIZED RELEASE EVALUATION = $78 00/hr 3 <br /> I i I 1 <br /> 5 <br /> C CONSULTATION FEE = S78 00/hr SAMPLING INSPECTION FEE = $78 00/hr , I S <br /> TOTAL DUE ;234.00 <br /> OR*0FICE USE ONLY _ _ _ _ <br /> ai i .. t 4 s—..-.- .. -sa.Si.J... S..»iii .1- »t.. .. .Ju-.4i...t ...i -» ..,Mi w—- i-�•«.«t..1.3..5- _-iL �..- �'I�_ � - ....5.« � ., i,S IIS, <br /> - <br /> SWEEPS CCMPUTER a ! LOC CODE DIST CODE I AMCUNT REC_IVEDCHECK J'/CASH I RECEIVED 3Y �- GATE RECEIVED <br /> 13 ! ------- �- - -- - -- <br /> 23 032 (REVISED 1-1248) <br />