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0 <br />uw v°w u aY�Y�W'�V I <br />-1997 10:21 AM FROM <br />51Ut SIN�IC HEALTH SERVICES - ENVIRow�aTAL 2 4 1997 <br />SmaAGE TANK PRosm - FEE <br />r'_ o <br />IUTAL <br />FACILITY SITE NAMEFACILITY <br />/ 41 !^7 <br />1417/ <br />CONTACT NAME <br />SAN JOAQUIN COUN <br />PUBLIC HEALTH SERVICES <br />Tvl"EALTH <br />FACILITY �E7S <br />DIVISION <br />SITE PHONE # with AREA <br />E <br />S <br />U <br />TEMPORARY CLOSURE (Plan Review & Inspections) <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br />b <br />CITY <br />STATE <br />ZIP CODE <br /># ofTANKS <br />A <br />INSTALLATION PLAN CHECK, (Plan Review & Conszruction Inspecttons) <br />XXXX <br />at SITE <br />P <br />P <br />APPLICANT/BILLING NAME <br />APPLICANT CONTACT NAME <br />L <br />A <br />C fb .s I <br />I <br />C <br />MAILING AOOR SS <br />APPLICANT WOKE # WITHFA GOD£ <br />A <br />P-37 <br />N <br />T <br />CITYf <br />STATE <br />Z P CODE <br />TYPE of APPLICATION <br />(Closure, In5tattation, etc.) <br />I XXXX <br />a. K <br />S XXX)=XX <br />T <br />V <br />TANK FEE $50.00/TANK (Prior to January 1,1991) <br />IUTAL <br />C <br />PERMANENT CLOSURE (Remova..'or Authorized Closure- in-PLace) <br />1986 <br />1987 <br />1988 <br />1989 <br />1990 <br />S <br />U <br />TEMPORARY CLOSURE (Plan Review & Inspections) <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br />R <br />EI <br />TEMPORARY CLOSURE FEE = s78.00lhour (3 hours minimum/FACILITY) <br />S?3r..00 minimum <br />5 <br />P <br />INSTALLATION PLAN CHECK, (Plan Review & Conszruction Inspecttons) <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />S XXXXXXXX <br />A <br />C <br />T <br />FACILITY PENALTY FEES ASSESSED (If Appticabte) <br />XXXX <br />XXXX <br />XXXX <br />I XXXX <br />XXXX <br />S XXX)=XX <br />T <br />V <br />TANK FEE $50.00/TANK (Prior to January 1,1991) <br />5170/TANK (After lam ry 1, 1991) <br />E <br /># Tanks = <br />1987 <br />1988 <br />1989 <br />1990 <br />1991 <br />1992 <br />1993 1994 <br />1995 <br />1996 <br />1997 <br />F <br />(multipty it by fee for <br />A <br />each year appticabte) <br />XXXX <br />XXXX <br />XXXX <br />xXXX <br />XXXX <br />S <br />I <br />TANK PENALTY FEES ASSESSED <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />S <br />L <br />I <br />STATE SURCHARGE FOR NEW FACILITIES ONLY = $18.50 <br />IS <br />T <br />Y <br /># Tanks x 58.00 <br />1988 through 1990 (S56) <br />1991 through 1996 (S56) <br />1997 <br />X)=XX XXX <br />XXXXXXXIOIXXXXXXXXXXXXXX <br />S <br />SURCHARGE FOR 1997 <br />C <br />PERMANENT CLOSURE (Remova..'or Authorized Closure- in-PLace) <br />TANK 1.0. #(s) <br />L <br />0 <br />CLOSURE FEE = 578.00/hour (3 hours minimum/TANK)-E- <br /># TANK(s) fir' X 5234-00 = <br />s 70 <br />S <br />U <br />TEMPORARY CLOSURE (Plan Review & Inspections) <br />TANK I.D. #(s) <br />R <br />EI <br />TEMPORARY CLOSURE FEE = s78.00lhour (3 hours minimum/FACILITY) <br />S?3r..00 minimum <br />5 <br />P <br />INSTALLATION PLAN CHECK, (Plan Review & Conszruction Inspecttons) <br />L <br />A <br />N <br />PLAN CHECK FEE - S78.00/hour (8 haus minimLo/FACILITY) = S624.00 minimum y / ' S <br />R <br />REPAIR FEE (Workplan Review S Comrruction Inspections) <br />TANK I.D. S(s) <br />E <br />P <br />TANK LINING REPAIR FEE = S78.00/hour (3 hours' mini mum/TANK) <br /># TANK(s) X s234.00 S <br />A <br />I <br />TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) <br />= S234.00 minimum s <br />R <br />PIPING REPAIR FEE = E78-00/hour (3 hours minimum /FACILITY) <br />5234.00 minimum Y <br />TRANSFER FEE = 520.00 I I UNAUTHORIZED RELEASE EVALUATION = 578-00/hr <br />I <br />S <br />C CONSULTATION FEE = 578.00/hr SAMPLING INSPECTION FEE = S78.00/hr <br />M OFFICE USE CULT <br />—':::" `s:::` ``' 'Y � "m. n uu'(�rxmu+mnr�inwn n tr�J1rerms+ -� nmecnnmm�ciamsc <br />I =_ =- € - _-_ :iE-li:ts_s:=:e-_ :w: :wmrwn a ui 1111m n uuna 1111 i. un u4�f 1e w�nxtan:munrmuur <br />SWEEPS x COMPUTER # I LOC CODE DIST CODE I AMOUNT RECEIVED f CHECK #/CASH <br />I s f <br />EH 23 032 (REVISED 5-27-97)�pp.L(J C) r� c� 7 P' <br />1 ! <br />RECEIVED BY I DATE RECEIVED <br />