COMPLIANCE INFO_1986-1994 - Laserfiche WebLink

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0 0 SAN JOAQUIN LOCAL HEALTH DISTRICT UH0[8U8OUH0 STORAGE TANK PROGRAM - FEE WORKSHEET F FACILITY/SITE NAME FACILITY CONTACT NAME R TANY REPAIR FEE $110.00 each TANK L STREET ADDRESS SITE PHONE I WITH AREA CODE Y CITY STAT -1IP CODE STATE SURCHARGE = $56.00 each TANK (see CA HEALTH t SAFETY CODE . Sec 25297 for applicability) T Y I Tanks x $56,00 (enter iiHht and year) 1987 1988 1999 hour tn be paid on plan submittal) A APPLICANT/BILLING NAME APPLICANT CONTACT NAME (when applicable) (when applicable) fvhen applicable) FEE I MAILING ADDRESS APPLICANT PHONE I WIT. AREA CODE TOTAL DUE -To CLOSURE, INSTALLATION, ETC. I? A -m e'" C ,A FACILITY FEE = $100.00 each SITE ADDRESS per YEAR 1986 1987 1988 1999 TOTAL R TANY REPAIR FEE $110.00 each TANK E TANK FEE = $50.00 each TANK F A C I Tanks x $50.00 H86 1987 1988 1989 (sultipTi-l-by fee for each year applicable) L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH t SAFETY CODE . Sec 25297 for applicability) T Y I Tanks x $56,00 (enter iiHht and year) 1987 1988 1999 hour tn be paid on plan submittal) IP PLAN CHECK (installation or Repair) INIPLAN CHECK FEE = $30.00 each SUBMISSION/RESUBMISSION REPAIR R TANY REPAIR FEE $110.00 each TANK I Tanks x $110.00 S A PIPING REPAJP/CLOSUPE /REMOVAL (fees are per hour, ainimum one hour tn be paid on plan submittal) IR U14AUTHORIZED RELEASE EVALUATION CONSTRUCTION INFECTION SAMPLING INSPECTION (when applicable) (when applicable) fvhen applicable) FEE TOTAL DUE OFFICE USE ONty SWEEPS I I COMP I I LOC CODEJ D I ST CODEJ AMOUNT DUE AMOUNT RrVO 1 CHECK I /CASH FCVD BY DATE RECEIVED PERMIT I