Laserfiche WebLink
SAN JOAQUIN CCITT PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVSION <br /> UI ,'ROUNO STORAGE TANK PROGRAM - FEE WORKSHEET <br /> S FACT hI TY SITE NAMEFACILITY CONTACT NAME <br /> I `—J1- �)G i s <br /> T <br /> 'E FACILITY ADDRESS'' SITE PHONE X with AREA CODE <br /> N W: <br /> �l C ATE 2[P CODE N of TANKS <br /> CITY —rR <br /> A 'F!F 'QT 53 at SITE <br /> P— acv <br /> CONTACT NAME <br /> P APPLICANT/SELLING NAME <br /> L 5 a,-Vu_ <br /> I APPLICANT PHONE k WITH AREA CODE <br /> C MAILING ADDRESS <br /> A <br /> N <br /> TI CITY STATE ZIP CODE TYPE of APPlt CATION <br /> (Closure, Installation, etc.) <br /> TOTAL <br /> 1986 1 1987 I 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.0. I XXXX I XXXX XXxX I %XXX I XXXX S xxxXXXXX <br /> Al <br /> TI FACILITY PENALTY FE'e5 ASSESSED Cif Applicable) <br /> XXXX F XXXX I XXXX I XX;;--1 XXXX 1 5 xxxxxxxx <br /> f <br /> V TANK FEE = 550.00/TANK (Prior to January 7,1991) I 5170/TANK (After January i, 1991) <br /> EI k Tanks = 1988 1 1989 1 1990 1991 1 7992 1993 1994 i 1995 1 1996 11997F (Wt' <br /> Al7y fee <br /> each[yearipty applicable)r %XXX =cx 1 XXXX X)= 1xxXX 1 1 ( 1 I 15 <br /> I TANK PENALTY FEES ASSESSED XXXX 1 XXXX 1 XXXX I XXXX (XXXX <br /> 15 <br /> L' 1 5 <br /> I -STATE SURCHARGE FOR NEW FACILITIES ONLY--S78.50 <br /> T1988 x 58.00 I 7988 through 1993 (556) 1993 through 1997 (556) <br /> YI <br /> SURCHARGE FOR 1998 xxxxxxxxxxxxXXXXXXxxxxXXXX% XXXXXXXXXXXXXXXXXXXXXXX l 5 <br /> Cj PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. x(s) <br /> L <br /> = 578.0./hour (3 hours minimum/TANK) S TANK(s)__ % 1734.00 = S <br /> 0i CLOSURE FEE <br /> S <br /> UI TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. S(s)I <br /> R S <br /> El TEMPORARY CLOSURE FEE 578.00/hour (3 hours minimm/FACILIT7) 5234.00 minintm <br /> P1 ENSTALLITTON PLAN CHECK (Plan Review 3 Construction inspections)j TANK i.7. :(s) <br /> L <br /> Al S <br /> NJ PLAN CHECK FEE = 578.00/hour (8 hours mini mm/FACILITY) = 5624.00 minimm <br /> RI REPAIR FEE (Workp(an Review d Construction Inspections) TANK L.O. 3(s) <br /> EJ S <br /> Pi TANK LINING REPAIR FEE = S78.00/hour (3 hours minimm/TANK) I N TANK(s) % 5234.00 ' t <br /> AI S <br /> I) TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) = S234.00 minimum i <br /> R I g <br /> I PIPING REPAIR FEE = S78.00/hour (3 hours minim nu FACILITY) = S234.00 minimm <br /> j <br /> MJ TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE B/ALUATICN = 578.30/hrS 1 1 I <br /> S s <br /> L CONSULTAT Tj FEE = S78.00/hr I 1 SAMPLINNGII,NSPEECC�T�ION FEE ,L= S78.00/hr I j <br /> 2.l• � �� �� T U..ifi'L Gt/'rr��l�C'v / TOTAL OUE � 1 <br /> - EPS � UTER '+ LOC CCDE j 0[ST CC.OE AMOUNT IECE I`/E0 CHECK :/USM I <br /> RECEIVED 3Y j ]Ai`c .RE•C_I`JED - <br /> ex 23 032 (ReiisEO 1-tz-9b) <br />