Laserfiche WebLink
SAN JOAQUIN COI. �' IC HEALTH SERVICES - ENVIRONMENTAL H& ION <br />r UNDk.GRM STORAGE TANK PROGRAM - FEE WtXSMEET <br />S <br />FACILITY SITE NAME/1 <br />CLOSURE <br />FACILITY CONTACT NAME <br />I <br />T <br />I <br />1P S w' <br />11988 11989 <br />i'' TK <br />'E <br />FACILITY ADDRESS <br />)&Q-7 oc I <br />SITE PHQNE 9 with AREA CODE <br />O Z <br />I ANNUAL FACILITY FEE (Prior to January 1, 7991) = 5100.00 <br />5234.00 minimumS <br />o - Z3 <br />5-L37 <br />TEMPORARY <br />CLOSURE <br />(Plan Review 8 Inspections) I <br />P <br />CITY c _ ) <br />v �, 1 otx <br />STATE Z P E 11 of TANKS <br />c 524 ac SITE 2— <br />CLOSURE <br />FEE - S78.00/hour (3 hours minimuNFACILITY) I <br />5234.00 minimumS <br />P <br />P <br />APPLICANT/BILLING NAME <br />F PL[CANY CONT E <br />L <br />!�/ce� <br />O ` I�LiI (I r <br />I <br />CONSULTATION FEE = <br />578.00/hr I I SAMPLING INSPECTION FEE <br />A <br />MAILING ADDRESS <br />APPLICANT PHONE Y WITX AREA CODE <br />005 <br />- /of� <br />N <br />C <br />T <br />CITY <br />ST <br />7ATE ZIP CTYPEAPPLICATION <br />Cr 2�I!C,InstatlaLion, GLC.) (-Ip5vt <br />TOTAL <br />C <br />PERMANENT <br />CLOSURE <br />(Removal or Authorized Closure -in -Place) I <br />7986 <br />1 1987 <br />11988 11989 <br />0 TANK(s)X S234.00 <br />11990 <br />R <br />i <br />I ANNUAL FACILITY FEE (Prior to January 1, 7991) = 5100.00 <br />5234.00 minimumS <br />U <br />TEMPORARY <br />CLOSURE <br />(Plan Review 8 Inspections) I <br />TANK I.D. #(S)_-- <br />(S)—_R <br />It <br />E <br />A <br />CLOSURE <br />FEE - S78.00/hour (3 hours minimuNFACILITY) I <br />5234.00 minimumS <br />)(XXX <br />I XXXXI <br />X%XX <br />xx%% <br />XXXX <br />S XXXXXXXX <br />S <br />C1 <br />CONSULTATION FEE = <br />578.00/hr I I SAMPLING INSPECTION FEE <br />= 578.00/hr I <br />S <br />I <br />C <br />T <br />FACILITY PENALTY FEES ASSESSED (If Applicable)I <br />XXXx <br />xxxx <br />X%%X <br />X%X% <br />X%X% <br />f X%X%XXxX <br />I <br />V <br />TANK FEE = S50.00/TANK <br />(Prior to January 1,1991) <br />I <br />S170/TANK <br />(After <br />January <br />1, <br />1991) <br />E <br />9 Tanks = <br />1988 1989 1990 1991 <br />11992 11993 <br />11994 <br />1995 <br />11996 11997 <br />1996 <br />F <br />A <br />(multiply 0 by fee for <br />each year applicable) <br />xxxx XXXx xxxx xxxx <br />Ixxxx I <br />I <br />I I <br />1 <br />S <br />D <br />I <br />TANK PENALTY FEES ASSESSED <br />I xxxx %XXX I x%%% I xxxx <br />Ixxxx I <br />I <br />I I <br />I <br />1 S <br />L <br />1 <br />STATE SURCHARGE FOR NEN FACILITIES ONLY -S18.50 <br />S <br />T1T <br />X Tanks x 38.00 <br />7988 through 1993 <br />($56) <br />7993 <br />through <br />1997 (556) <br />7998 <br />SURCHARGE FOR 1998 <br />xxxxxxxxxxxxxxxxxxxxxxxxxxx <br />%%xxxxxxxxxxxxxxxxxxxxx <br />I S <br />C <br />PERMANENT <br />CLOSURE <br />(Removal or Authorized Closure -in -Place) I <br />TANK I.D. x(s) <br />L <br />0 <br />CLOSURE FEE = 578.00/hour (3 hours miniffLWTANK) I <br />0 TANK(s)X S234.00 <br />S <br />R <br />REPAIR FEE <br />= 578.00/hour (3 hours minimim/FACILITY) = <br />5234.00 minimumS <br />U <br />TEMPORARY <br />CLOSURE <br />(Plan Review 8 Inspections) I <br />TANK I.D. #(S)_-- <br />(S)—_R <br />It <br />E <br />TEMPORARY <br />CLOSURE <br />FEE - S78.00/hour (3 hours minimuNFACILITY) I <br />5234.00 minimumS <br />I <br />' P INSTALLATION PLAN CHECK (Plan Review b Construction Inspections)I TANK I.D. 0(s) <br />L <br />y A <br />I N PLAN CHECK FEE = S78.00/hour (8 hours minimum/FACILITY) = 5624.00 minimum <br />111 R REPAIR FEE (Workplan Review i Construction Inspections) I TANK I.D. R(s) <br />E <br />S <br />1 P <br />TANK LINING REPAIR <br />FEE = S78.00/hour (3 hours minimum/TANK) I 0 <br />TANK(s) _ X 5734.00 = <br />S <br />A <br />I <br />'TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = <br />S234.00 minimum <br />S <br />1 <br />R <br />REPAIR FEE <br />= 578.00/hour (3 hours minimim/FACILITY) = <br />5234.00 minimumS <br />IPIPING <br />MI <br />TRANSFER FEE = <br />$20.00 I i UNAUTHORIZED RELEASE EVALUATION <br />- S78.00/hr I I <br />I S <br />IF <br />S <br />C1 <br />CONSULTATION FEE = <br />578.00/hr I I SAMPLING INSPECTION FEE <br />= 578.00/hr I <br />S <br />I <br />TOTAL DUE I S <br />FOR OFFICE USE ONLY <br />._.ter.__..""-'•'�'�._._'_'_,�s_y_' ___— .-:,—�«._.__. _�_va_-�.� <br />SWEEPS 3 I COMPUTER x LOC CODE I DIST CODE I AMOUNT RECEIVED CHECK Y/CASH RECEIVED BY I DATE <br />rw 7; n;7 (RFVISFO 1.12-98) <br />