Laserfiche WebLink
- 1- \j C) i ct, -A, O ' 0 <br />SAN JOAQUIN CL PUBLIC HEALTH SERVICES - BIVIROMEMTAL H DIVSION <br />UND, GROUID STORAGE TANK PROGRAM - FEE WORKSHEET <br />S <br />FACILIT SIT NAME <br />FACIL TY CONTACT NAME <br />T <br />L <br />A <br /># TANK(s) X $234.00 = $ <br />E <br />FACILITY ADDRESSSITE <br />PHPNEj wit AREA CODE <br />S <br />S <br />U <br />R <br />CITY <br />STATEZIP <br />CODE <br /># of TANKS <br />Aat <br />P <br />ANNUAL FACILITY FEE (Prior <br />SITE <br />P <br />APPLICANT/ ILLI G NAME <br />APPLI N CONTACT NAME <br />L <br />AMN <br />ca <br />I <br />A <br />C <br />MAILING ADDRESS <br />APPLIC PH NE # WITH AREA COD <br />N <br />L -s <br />O 3 "' <br />T <br />CITYTE <br />S <br />I <br />Y APPLICATION <br />su Installation, etc.) <br />C <br />PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) <br />TANK I.D. #(s) <br />E <br />P <br />L <br />A <br /># TANK(s) X $234.00 = $ <br />L <br />0 <br />CLOSURE FEE = $78.00/hour (3 hours minimum/TANK) <br />TOTAL <br />S <br />S <br />U <br />R <br />TEMPORARY CLOSURE (Plan Review & Inspections) <br />1986 <br />1987 <br />1988 <br />1989 1990 <br />ANNUAL FACILITY FEE (Prior <br />to January 1, 1991) = <br />S100.00 <br />XXXX <br />XXXX <br />XXXX <br />S <br />A <br />C <br />T <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />XXXX <br />XXXX <br />xxxx <br />S <br />I <br />V <br />TANK FEE = 550.00/TANK <br />(Prior to January 1,1991) <br />$170/TANK <br />(After <br />January <br />1, 1991) <br />E <br /># Tanks = <br />1986 1987 1988 <br />1989 <br />1990 1991 1992 <br />1993 <br />1994 <br />1995 1996 <br />F <br />A <br />(multiply W-Ey—fee for <br />applicable) <br />XXXX XXXX XXXX <br />$ <br />C <br />each year <br />I <br />TANK PENALTY FEES ASSESSED <br />-XXXX XXXX XXXX <br />S <br />L <br />I <br />STATE SURCHARGE = $56.00 <br />each TANK (Due every 5 <br />years) <br />See California H & <br />S Code, <br />Section <br />25287 <br />T <br />Y <br /># Tanks x $56.00 <br />1986 through <br />1990 <br />1991 <br />through <br />1996 <br />(Enter amount and year) <br />S <br />C <br />PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) <br />TANK I.D. #(s) <br />E <br />P <br />L <br />A <br /># TANK(s) X $234.00 = $ <br />L <br />0 <br />CLOSURE FEE = $78.00/hour (3 hours minimum/TANK) <br /># TANK(s)_-t$ X 5234.00 = $ <br />S <br />S <br />U <br />R <br />TEMPORARY CLOSURE (Plan Review & Inspections) <br />TANK I.D. #(s) <br />E <br />TEMPORARY CLOSURE FEE = 578.00/hour (3 hours minimum/FACILITY) <br />$234.00 minimum $ <br />P <br />INSTALLATION PLAN CHECK (Plan Review & Construction Inspections)TANK I.D. #(s) <br />TANK I.D. #(s) <br />E <br />P <br />L <br />A <br /># TANK(s) X $234.00 = $ <br />A <br />I <br />N <br />PLAN CHECK FEE = 578.00/hour (8 hours minimum/FACILITY) = $624.00 minimum <br />S <br />R <br />REPAIR FEE (Workplan Review & Construction Inspections) <br />TANK I.D. #(s) <br />E <br />P <br />TANK LINING REPAIR FEE = E78.00/hour (3 hours minimum/TANK) <br /># TANK(s) X $234.00 = $ <br />A <br />I <br />TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) <br />= $234.00 minimum $ <br />R <br />PIPING REPAIR FEE = 578.00/hour (3 hours minimm/FACILITY) <br />= $234.00 minimum $ <br />NJ TRANSFER FEE = $20.00 <br />I <br />S <br />C CONSULTATION FEE = 578.00/hr <br />UNAUTHORIZED RELEASE EVALUATION = 578.00/hr <br />SAMPLING INSPECTION FEE = 578.00/hr <br />EH 23 032 (REVISED 4-29-94) Page 11 <br />S <br />+$$$ TOTAL DUE <br />