Laserfiche WebLink
­9 JOACUiN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WCRKSHEET <br /> FACILITY SITE NAME FACILITY CYNJACT NAME <br /> FGLCvy1f� y� LviS Ve/Q� <br /> A , <br /> I FACILITY ADDRESS _ I SITE PHONE 0 with AREA CODE <br /> 1 2 5 thef" S� <br /> 1 <br /> T CITY STATE IZIP CODE I of TANKS <br /> Y C/iz.'t-j� I at SITE <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P �A . <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE # WITH-AREA CODE <br /> G S �l Sfr ` 2 (2y - 583 - O ZN/ <br /> A <br /> N CITY ,,., s 5 TE CCOE TYPE f APPLLCelIIT `„ ` IZIP <br /> 7 3G�G> OSURE STALLA7IC etc. <br /> TOTAL <br /> A <br /> C 1986 1987 1 1988 1 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = S100.00 <br /> I S <br /> V <br /> E TANK FEE = $50.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F R Tanks = 1986 1987 1988 1489 11990 1991 1992 11993 1 1994 1 1995 1996 <br /> A (multiply : by fee for <br /> C each year applicable) I I I I I S <br /> I <br /> L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> I <br /> T 0 Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) <br /> ' S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) I TANK I.D. '(s) <br /> C <br /> L CLOSURE FEE = S53.00 per hour (3 hours minimum per TANK) I TANK(s) X 5159.00 = S <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review 8 inspections TANK I.D. '(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = $150.00 each TANK TANK(s) X 5150.00 = S <br /> P PLAN CHECK (Install. Plan Review 8 Construction Inspections) TANK I.D. #(s) <br /> L <br /> A _W !, i Q 4 <br /> N PLAN CHECK FEE - S53.00 per hour (8 hours minimum per Facility) = S424.00 minimum S <br /> R REPAIR TANK I.D. :(s) <br /> E <br /> P TANK REPAIR FEE = S53.00 per hour (3 hours minimum/TANK) I TANK(s) X 5159.00 = S <br /> A <br /> I <br /> R PIPING REPAIR REVIEW 8 CONSTRUCTION = S53.00 per hour (3 hour minimum per facility = S159.00) $ <br /> M CONSULTATIONS UNAUTHORIZED RELEASEE EVALUATION SAMPLING INSPECTION <br /> I <br /> S <br /> C FEE = S53.00/hr T FEE = S53.00/hr I FEE = S 53.00/hr <br /> TOTAL DUE S 2 <br /> OFFICE USE ONLY <br /> ......_.........................--_.._.._...............................................................................................................................................................__.........._........................_ <br /> rt t rs as sW saw ecs �: _ - •Z 2SZX max ass! <br /> C_ - I L.6F'CObc ~�'i�TYC:Cc I. •aMCUN; RC'�T)" C;ic <"� C S�' C`iD oYDy�c z< .a < <br /> L 6WOL'al1.S :�/ ?2 `. ...���,�_�yU9� � ►i�l.y�i. ...... . <br />