BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN LOCAL HEALTH DISTRICT ——- UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET ILITY/SITE NAME FACILITY CONTACT NAME 17C� !_"� .ZN�ccSTr, ts�—Z�vC �b.✓ L{� r.' f& r''.v^ , L STREEI ADDRESS ST SITE PHONE 1 WITH AREA Coo. CT 2 :^ [;2AIaLING OAls STAT ZIP CODE B of Tanksjy ,,at Site � ' fq?qBILLING NAME ^--" APPLICANT CONTACT NAMEI 'lci. `k/C164.DRESS PPLICANT PHONE 1 MITN A.eA cone 7Y-3 72 2CO- r � r 51-N _"'_____-___. STA E O APPLICATION Tc1� a N ZIP'CODE (:-' 2 LoauA[ INATALLAT tor, erc. —-- --- _ _ FACILITY IEE 4100,00 each SITE ADDRESS per YEAR _ A_._"._._._._------ _ TOTAL T 1986 1987 1988 1989 1 V 1 E TANK FEE = $50.00 each TANK F t Tanks _ x $50.00 1986 1987 1988 1989 A (eultipry (-by fee for _ - C each year applicable) - I — ��------ L STATE SURCHARGE _ $56.00 each TANK (see CA HEALTH 8 SAFETY CODE Sec 25287 for applicability) T 1 Tanks x $56.00 1986 1987A - 1988 Y (enter iiouit and year) 'T 1989 -- -- — - ___. off. � Fey C PERMANENT CLOSURE enoval r Closure in pl'�d�j�/�+�q LTEMPORARY E FEE _ $90.00 each TANK ��(;rQ�, l Tanks__[_ x $90.00 $ 9G C Q RY CLOSURE (Only allowed one time for up to twoL`y'jf�eaIs �S CLOSURE FEE _ $80.00 each TANK — _ ......_-_—.,- 1 nks x 480.00 $ P PLAN CHECK (Installation or Repair) -- A - H PLAN CHECK FEE = 130.00 each SUBMISSION/RESUDMISSIOH REPAIR —� R TANK, REPAIR FEE _ $110.00 each TANK —'"-' --- -- — --__ E. ___.-.._ .__._.- _ 1 Tanks x 1110.00 $ A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) I -- -- -- --- ___ R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION - _-- (when applicable) (when a liable) SAMPLING INSPECTION ----............. ._-------_.__.__. .._._"_..._pp._-._..__ .-_.__.__ (when applicable) FEE _ $30.00/hrl - - — PEE _ $35.00/hr — FEE $35 - ---- --. _ .00/hrj OFFICE USE ONLY TOTAL DUE f SNEEPS t COMP 1 LOC COUE DIST CODE AMOUNT DUE AMOUNT RCVD CHEC 1/CASH Rryp Av DATE P,ECEIVED PEP,MIT $ � 015