Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION <br />UNDERGF -'.,J STORAGE TANK PROGRAP -[ WORKSHEET <br />FACILITY NAME <br />FACILITY CONTACT NAME <br />CLOSURE FEE = $267 / TANK <br />1996-1999 <br />FACILITY ADDRESS <br />SITE PHONE # WITH AREA CODE <br />TEMPORARY CLOSURE FEE = $267 / FACILITY <br />$500 FEE INCLUDES FACILITY FEE +I TANK <br />CITY <br />STATE <br />ZIP CODE <br /># OF TANKS AT SITE <br />CIRCLE WORK TO BE DONE: <br />Closure Installation Repair Retrofit <br />CA <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />CLOSURE FEE = $267 / TANK <br />1996-1999 <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />TEMPORARY CLOSURE FEE = $267 / FACILITY <br />$500 FEE INCLUDES FACILITY FEE +I TANK <br />CITYSTATE <br />PIPING REPAIR FEE = $267 / FACILITY <br />ZIP <br />CODE <br />CIRCLE WORK TO BE DONE: <br />Closure Installation Repair Retrofit <br />ACTIVE FACILITY <br />TANK ID # Is): <br />CLOSURE FEE = $267 / TANK <br />1996-1999 <br />2000 <br />2001 <br />TEMPORARY CLOSURE FEE = $267 / FACILITY <br />$500 FEE INCLUDES FACILITY FEE +I TANK <br />($170)X(#tanks) X(#of yearsapplioable) <br />PIPING REPAIR FEE = $267 / FACILITY <br />$ <br />$125 PER TANK AFTER FIRST TANK <br />SAMPLING INSPECTION FEE _ $ 89/ HOUR <br />$ <br />$ <br />TANK PENALTY ASSESSED <br />/- <br />$3.00 <br />TANK SURCHARGE =$8/TANK <br />1-760 <br />$ / <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM = $ /FACILITY <br />/ <br />PERMANENTCLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # Is): <br />CLOSURE FEE = $267 / TANK <br />I # TANKS X $267 = <br />TEMPORARY CLOSURE <br />Plan Review and Inspections <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = $267 / FACILITY <br />INSTALLATION PLAN CHECK <br />Plan Check and Construction Inspections) <br />TANK ID # (s) : <br />PLAN CHECK FEE = $712 / FACILITY <br />r <br />i <br />V <br />REPAIR PLAN CHECK <br />I FACILITY ID <br />TANK ID # (s): <br />CHECK# <br />TANK LINING REPAIR FEE = $267 / TANK <br /># TANKS X $267 = <br />$ <br />TANK RETROFIT REPAIR FEE = $267 / FACILITY <br />$ <br />PIPING REPAIR FEE = $267 / FACILITY <br />$ <br />MISCELLANEOUS <br />I FACILITY ID <br />AMOUNT RECEIVED <br />CHECK# <br />TRANSFER FEE _ $ 20 <br />DATE <br />RECEIVED <br />SR <br />CONSULTATION FEE _ $ 89/ HOUR <br />UNAUTHORIZED RELEASE EVALUATION FEE _ $ 89 /HOUR <br />SAMPLING INSPECTION FEE _ $ 89/ HOUR <br />ALL FEES ARE BASED ON THE $89 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br />OFFICE USE ONLY <br />SERVICE REQUEST If <br />I FACILITY ID <br />AMOUNT RECEIVED <br />CHECK# <br />RECEIVED BY <br />DATE <br />RECEIVED <br />SR <br />EH 23 032 (REVISED 8-1-01)V 0 <br />L(00- Ste— — -}a E -K <br />