Laserfiche WebLink
' - SAN JOADUIN L�IY PUBLIC HMTH SERVICES - ENVIRONMENTAL . ,TN OIVSICN <br /> UNDERGROLM STORAGE TANK PROGRAM - FEE WORKSHEET <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> T <br /> E FACILITY ADDRESS SITE PHONE 0 with AREA CODE <br /> & � U en <br /> CITY C -{�v>✓ STA E ZIP CODE at SITE KS <br /> A <br /> P <br /> PAPPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> re. D 111/7 c � <br /> C NAILING ADDRESS (��J f7�k T('Lp-vy(cz-o� �.7I �� APPLICANT PHONE d WITH AREA CODE <br /> A <br /> N <br /> T CIT7 3 3 ��) ���� �D N TATE ZIP CODE TYPE of APPLICATION <br /> —� L C JG�O (Closure, Installation, etc.) <br /> TOTAL <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) 5100.00 1986 1987 1988 1989 1 1990 <br /> A XXXX =(xc l o o I GG - s 0 9%OS <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) KXXXX XXXX I (iG G( f `1 ?70z- <br /> 1 <br /> V TANK FEE = SSO.00/TANK (Prior to Jarxmry 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> Y Tanks = 1 1986 1987 1 1988 1 1989 1990 1991 1992 1993 1994 11995 1 1996 <br /> F (multiply 0 by fee for <br /> A each year applicable) X)= root % 5 0 5 o I . a I s 1 S6) <br /> C <br /> 1 TANK PENALTY FEES ASSESSED XXXX XXXX c� ��i ,� ,(} 5 <br /> 3 I STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 -/ <br /> T <br /> T I Tanks X 556.00 1988 through 1990 1991 through 1996 <br /> (Enter amount and year) <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.O. x(s) <br /> Ll I <br /> Sf CLOSURE FEE - 578.00/hour (3 hours minimum/TANK) x TANK(s)_� X 5234.00 = S <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) TANK 1.0. B(s) <br /> R <br /> E TEMPORARY CLOSURE FEE - 578.00/hour (3 hours minimum/FACILITY) 5234.00 minimum S <br /> PI INSTALLATION PLAN CHECK (Ptan Review & Construction Inspections) TANK I.D. 4(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = 578.00/hwr (8 hours minimum/FACILITY) = S624.00 minimum S <br /> R REPAIR FEE (Workplan Review & Construction Inspections) I TANK I.O. $(a) <br /> E <br /> P TANK LINING REPAIR FEE = 5$.00/hour (3 hours minimum/TANK) I x TANK(s) X 5234.00 = s <br /> A <br /> I TANK RETROFIT REPAIR FEE - S713.00/hour (3 hours min./FACILITY) = S234.00 minimum 5 <br /> R <br /> PIPING REPAIR FEE = S78.00/hour (3 hours minimnm/FACILITY) = S234.00 minimum 5 <br /> M TRANSFER FEE = S20.00 UNAUTHORIZED RELEASE EVALUATION - 578.00/hr s <br /> i <br /> S <br /> C� CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE G = 578.00/hr <br /> l O j3 • C • 1 (o / y L—nQ TOTAL DUE <br /> FOR OFFICE USE ONLY <br /> SWEEPS x I COMPUTER I LOC CODE I DIST CODE I AMOUNT RECEIVED CHECK f/CASH RECEIVED BT DATE RECEIVED <br /> EH 23 032 (REVISED 10-28-93) A �1/ <br />