Laserfiche WebLink
SAN JOAQUIN COUN081IC HEALTH SERVICES - ENVIRONMENTAL HEALTI ION <br />UNDERGROUND STORAGE TANK Poncaew - eec..��«. <br />S <br />T <br />FACILITY SITE NAME (''' �1 <br />C40SFm1S SAJNi��S �4z <br />AME <br />FAhoIrrER N� <br />1986 <br />1987 <br />r OS rJ <br />E <br />FACILITY ADDRESS <br />�� ��7ro ��. <br />SITE PHONE # with AREA CODE <br />= S78.00/hr I <br />nl <br />o - 51) <br />P <br />CIT <br />�� �ALgF, <br />STATE <br />��• <br />ZIP CODE <br />X15366 <br /># of TANKS <br />at SITE 3 tomP1q2Tr11W <br />P <br />APPLICANT/BILLING NAME <br />56 <br />APPLICANT CONTACT NAME <br />1 <br />10? <br />C <br />N <br />MAILING ADDRESS <br />7 �a��. 7 �. <br />APPLICANT PHONE # WITH AREA CODE <br />V <br />E <br />TANK FEE = 250.00/TANK (Prior to Jaruary 1,1991) <br />aog- sa - 653 <br />T <br />CITY <br />%i%O�JES %� <br />STATE <br />ZLP CODE <br />TYPE of APPLICATION /f1/STAuLgT70rj <br />4 Tanks = <br />1986 1987 <br />535—� <br />(closure, Installation, etc.) <br />M TRANSFER FEE <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = 2100.00 <br />UNAUTHORIZED RELEASE EVALUATION <br />1986 <br />1987 <br />1988 <br />1989 <br />1990 <br />C I CONSULTATION FEE <br />= S78.00/hr I <br />I SAMPLING INSPECTION FEE <br />= 578.00/hr I I I S <br />A <br />C <br />S <br />T <br />I <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />XXXX <br />X)= <br />S <br />V <br />E <br />TANK FEE = 250.00/TANK (Prior to Jaruary 1,1991) <br />2170/TANK <br />(After <br />January <br />1, 1991) <br />4 Tanks = <br />1986 1987 <br />1988 <br />1989 <br />1990 <br />1 1991 <br />1992 <br />1 1993 1 <br />1994 <br />1 1995 <br />1996 <br />F <br />(multiply # -by fee for <br />A <br />each year applicable)2 <br />C <br />I <br />TANK PENALTY FEES ASSESSED <br />XXXX XXXX <br />L <br />S <br />1 <br />STATE SURCHARGE = 256.00 each TANK (Due every 5 years) See California H & S Code, <br />Section 25287 <br />T <br />Y <br /># Tanks z 556.00 <br />1986 through 1990 <br />1991 through 1996 <br />(Enter amount and year) <br />S <br />C <br />PERMANENT CLOSURE (Removal or Authorized Ctosure-in-Place) <br />TANK I.D. #(s) <br />L <br />0 <br />CLOSURE FEE = 278.00/hour (3 hours minim n/TANK) <br /># TANK(s)_ X <br />2234.00 = <br />S <br />S <br />U <br />TEMPORARY CLOSURE (Plan Review & Inspections) <br />TANK I.D. #(s) <br />R <br />E <br />TEMPORARY CLOSURE FEE = 278.00/hour (3 hours minimm/FACILITY) <br />5234.00 minimum <br />S <br />P <br />INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) <br />TANK I.D. #(s) <br />L <br />A <br />N <br />PLAN CHECK FEE = 278.00/hour (8 hours minimm/ FACILITY) <br />= 2624.00 minimus <br />5 �� y 00 <br />.R <br />REPAIR FEE (Workplan Review & Construction Irepeotians) <br />E <br />P <br />TANK LINING REPAIR FEE = S78.00/hour (3 hours minimm/TANK) <br /># TANK(s) X <br />2234.00 = <br />S <br />A <br />I <br />TANK RETROFIT REPAIR FEE = 278.00/hour (3 hours min./FACILITY) <br />= 2234.00 minimum <br />$ <br />R <br />PIPING REPAIR FEE = S78.00/hour (3 hours minimuVFACILITY) <br />= 2234.00 minimum <br />S <br />M TRANSFER FEE <br />= S20.00 <br />UNAUTHORIZED RELEASE EVALUATION <br />= 578.00/hr 2 <br />S <br />C I CONSULTATION FEE <br />= S78.00/hr I <br />I SAMPLING INSPECTION FEE <br />= 578.00/hr I I I S <br />TOTAL DUE 12 6'";?q (go <br />FOR OFFICE USE ONLY <br />EH 23 032 (REVISED 3-1-931 <br />