Laserfiche WebLink
01y-' \�o <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY CONTACT NAME <br /> FACILITY SITE NAME <br /> F <br /> p <br /> C SITE PHONE # with AREA CODE <br /> I FACILITY ADDRESS <br /> L <br /> I TATE ZIP CODE # of TANKS <br /> T CITY at SITE -2- <br /> Y <br /> G LD.t� Com/ <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P / — <br /> P <br /> L APPLICANT PHONE # WITH AREA CODE <br /> I MAILING ADDRESS <br /> D p, o . 63o r sd6o <br /> A <br /> STATE ZIP CODE TYPE of APPLICATION <br /> N CITY <br /> T r "le /v--? Gy gs 7- UR INSTALLATION, etc. <br /> d TOTAL <br /> A <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = 8100.00 <br /> I 8 <br /> V <br /> E TANK FEE = 850.00/TANK (prior to January 1,1991) 8170/TANK (after January 1, 1991) C7_. <br /> F # Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1 1994 1 1995 1996 <br /> A (multiply #by fee for <br /> C each year applicable) E s o <br /> I <br /> L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 <br /> 1 <br /> T # Tanks x 856.00 1986 through 1990 1991 through 1996 y� r/ <br /> Y (enter amount and year) <br /> PERMANENT CLOSURE (RemovaL or Authorized Closure-in-Place) TANK I.O. #(s) <br /> C <br /> L CLOSURE FEE = 853.00 per hour (3 hours minimum per TANK) # TANK(s)_ X 8159.00 = E <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review & inspections TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = 8150.00 each TANK # TANK(s) _ X 8150.00 = E <br /> P PLAN CHECK (Install. Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - 853.00 per hour (8 hours mini mum per Facility) = 8424.00 minimum E <br /> R REPAIR TANK I.D. #(s) <br /> E <br /> P TANK REPAIR FEE = 853.00 per hour (3 hours minimum/TANK) # TANK(s) _ X $159.00 = 8 <br /> A <br /> I <br /> R PIPING REPAIR REVIEW & CONSTRUCTION = 853.00 per hour (3 hour mini mm per facility = $159.00) S <br /> M CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> 5 <br /> C FEE = 853.00/hr FEE 853.00/hr FEE = E 53.00/hr <br /> TOTAL DUE S <br /> OFFICE USE ONLY <br /> '.6"f°S' <br /> z E » <br /> W'R�AXA ALY;.LIYi>Wt �i>%ATB%AD17AY#Y.BAYrD A%>YA]3'S&YSA'S S.Yk.EYUY�::.'nf�'bSW`.:1.IX^.`i.,^.).Y:v"p.`�l:i:Y::y^:.r:��5�`.Y55�:Y»#:GnLY.'0Y:Y:SY�fR.`AY�tAT6 9.litRAV 0.i plY fli�YY�X�l1iAWY�YM <br /> ... - nrn .-.-. �++ _.On• e- - - Onnn tt <br />