Laserfiche WebLink
• SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGRO,,,,,D STORAGE TANK PROGRAM FES WORKSHEET <br /> FACILITY NAME FACILITY CONTACT NAME <br /> 1+^t t le- P A I <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 0 <br /> F1_0f 7 2,0 - -,-1/;?, <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> CA �'� ^ ' <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> C _ 7-,—(.,e P �' C� _ / <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> !G l �-4 /2 SO2 5 y`2. <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE: <br /> C) Closure Installationep ' Retrofit <br /> ACTIVE FACILITY <br /> 1995- 1999 2000 <br /> $500 FEE INCLUDES FACILITY FEE + 1 TANK ($174)X(#tanks)X(#of years applicable) <br /> $125 PER TANK AFTER FIRST TANK $ <br /> $ <br /> TANK PENALTY ASSESSED <br /> $ <br /> TANK SURCHARGE=$8/TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=S10/FACILITY <br /> PERMANENTCLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID#(s): CLOSURE FEE=$261 /TANK #TANKS X 5261 = <br /> TEMPORARY CLOSURE <br /> (Plan Review and Inspections) <br /> $ <br /> TEMPORARY CLOSURE FEE_$261 /FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> $ <br /> TANK ID#(s): PLAN CHECK FEE_$6961 FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID# s <br /> TANK LINING REPAIR FEE =$261 /TANK #TANKS X$261.= <br /> TANK RETROFIT REPAIR FEE =$261 /FACILITY <br /> $ <br /> PIPING REPAIR FEE _$2611 FACILITY <br /> MISCELLANEOUS <br /> $ <br /> TRANSFER FEE = S20 <br /> CONSULTATION FEE = S 871 HOUR <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $871 HOUR <br /> SAMPLING INSPECTION FEE = $87/HOUR <br /> ALL FEES ARE BASED ON THE$97 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL HE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# 1 FACILITY ID AMOUNT RECEIVED I CHECK# RECEIVED 13Y DATE RECEIVED <br /> SR <br />