COMPLIANCE INFO_1998-2007 - Laserfiche WebLink

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SAN JOAQUIN. COUNTY ENVIRONMENTAL HEALTH DEPARTMENT . UNDERGR D STORAGE TANK PROGRAM WORKSHEET mf FACILITY NAME FACILITY CONTACT NAME J'A CP 1999 2000 FACILITY ADDRESS SITE PHONE # WITH EA CODE $500 FEE INCLUDES FACILITY FEE + 1 TANK APPLICANT MAILING ADDRESS CITY v STATE ZIP CODE 115I(ZI) # OF TANKS AT SITE 6Ct D� CA .�� -9 3 - APPLICANT BILLING NAME TANK ID # (s): APPLICANT CONTACT NAME 1999 2000 2001 1141,-21 h�417 2004 $500 FEE INCLUDES FACILITY FEE + 1 TANK APPLICANT MAILING ADDRESS $ APPLICANT PHONE # WITH EA CODE 115I(ZI) $ 91 3-96 IV -9 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE• Closure Installation Repair Retrofit _9'�` -1 ACTIVE FACILITY TANK ID # (s): CLOSURE FEE = $279 / TANK 1999 2000 2001 2002 2003 2004 $500 FEE INCLUDES FACILITY FEE + 1 TANK ($170) X (#tanks) $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR $ SAMPLING INSPECTION FEE = $ 93/ HOUR $125 PER TANK AFTER FIRST TANK $ TANK PENALTY ASSESSED $ TANK SURCHARGE = $15 / TANK $ STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$24.00/ FACILITY PERMANENT CLOSURE Removal or Permitted Closure in Place TANK ID # (s): CLOSURE FEE = $279 / TANK # TANKS X $279 = TEMPORARY CLOSURE Plan Review and Inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $279 / FACILITY Check and Construction I TANK ID # (s) : I PLAN CHECK FEE = $744 / FACILITY REPAIR PLAN CHECK TANK ID # (s): TANK RETROFIT REPAIR FEE = $279 / FACILITY (use for monitoring equipment, spill buckets, tank sumps, misc.) $ 2-7 PIPING REPAIR FEE = $279 / FACILITY (use for piping, under -dispenser containment, ect.) $ MISCELLANEOUS $ TRANSFER FEE _ $ 20 $ CONSULTATION FEE = $ 93/ HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR $ SAMPLING INSPECTION FEE = $ 93/ HOUR ALL FEES ARE BASED ON THE $93 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. OFFICE USE ONLY BY I DATE SR EH 23 032 (REVISED