COMPLIANCE INFO_1994-2001 - Laserfiche WebLink

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SAN JOAQUINAGROUND PL13LIC HEALTH SERVICES - ENVIRONMENTAL H DIVSION STORAGE TANK PROGRAM - FEE WORKSH S FACILITY SITE NAME FACILITY CONTACT NAME I 1987 1988 1989 1990 A T 0 CLOSURE FEE = $78.00/hour (3 hours mini TANK) E FACILITY ADDRESS SITE PHONE # with AREA CODE A & TANK RETROFIT REPAIR FEE = S78.00/hour (3 hairs min./FACILITY) A U XXXX XXXX CITY STATE ZIP CODE # of TANKS A = S234.00 minimum S E at SITE $234.00 minimum C P P APPLICANT/BILLING NAME APPLICANT CONTACT NAME L S I C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE A V TANK FEE _ $50.00/TANK (Prior to January 1,1991) $170/TANK (After January 1, 1991) E N 1986 1987 1988 1989 1990 1991 TCITY 1993 1994 STATE ZIP CODE TYPE of APPLICATION (multiply # by fee for each year applicable) XXXX XXXX (Closure, Installation, etc.) TOTAL PERMANENT CLOSURE (Removal or Authorized Ctosure-in-Place) TANK I.D. #(s) 1986 1987 1988 1989 1990 A ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 0 CLOSURE FEE = $78.00/hour (3 hours mini TANK) # TANK(s) X $234.00 = S A S TANK RETROFIT REPAIR FEE = S78.00/hour (3 hairs min./FACILITY) A U XXXX XXXX R $ R PIPING REPAIR FEE = $78.00/hour (3 hairs minimm/FACILITY) = S234.00 minimum S E TEMPORARY CLOSURE FEE _ $78.00/hour (3 hours minimum/FACILITY) $234.00 minimum C T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XXXX S I V TANK FEE _ $50.00/TANK (Prior to January 1,1991) $170/TANK (After January 1, 1991) E # Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 F A (multiply # by fee for each year applicable) XXXX XXXX S C I TANK PENALTY FEES ASSESSED XXXX XXXX I S L I STATE SURCHARGE = S56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 T Y # Tanks x $56.00 1988 through 1990 1991 through 1996 (Enter amount and year) S C PERMANENT CLOSURE (Removal or Authorized Ctosure-in-Place) TANK I.D. #(s) L A P 0 CLOSURE FEE = $78.00/hour (3 hours mini TANK) # TANK(s) X $234.00 = S A S TANK RETROFIT REPAIR FEE = S78.00/hour (3 hairs min./FACILITY) _ $234.00 minimum S U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) R R PIPING REPAIR FEE = $78.00/hour (3 hairs minimm/FACILITY) = S234.00 minimum S E TEMPORARY CLOSURE FEE _ $78.00/hour (3 hours minimum/FACILITY) $234.00 minimum $ P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) YANK I.D. #(s) L A P N PLAN CHECK FEE = S78.00/hour (8 hours minioAVFACILITY) _ $624.00 minimum S R REPAIR FEE (Workplan Review & Construction Inspections) TANK I.D. #(s) E P TANK LINING REPAIR FEE = S78.00/hour (3 hours miniman/TANK) # TANK(s) X 5234.00 = S A I TANK RETROFIT REPAIR FEE = S78.00/hour (3 hairs min./FACILITY) _ $234.00 minimum S R PIPING REPAIR FEE = $78.00/hour (3 hairs minimm/FACILITY) = S234.00 minimum S 11 TRANSFER FEE _ $20.00 t CONSULTATION FEE = 578.00/hr FOR OFFICE USE ONLY UNAUTHORIZED RELEASE EVALUATION = S78.00/hr SAMPLING INSPECTION FEE = $78.00/hr S P TOTAL DUE i S EH 23 032 (REVISED 10-28-93)