Laserfiche WebLink
• SAN JOAQUIN C& PUBLIC HEALTH SERVICES - ENVIRONMENTAL He OIVSION <br /> UNOERGXUNO STCRAGE TANK PROGRAM - FEE uCRIMUMT <br /> SI FACILITY SITE NAME- FACILITY CONTACT NAME <br /> T <br /> E FACILITY ADDRESS SITE PHONE It with AREA CODE <br /> & 5(Z-5 E• 0'e4 G� <br /> CITY STATE ZIP CODE x of TANKS <br /> A �(� 2 at SITE <br /> P <br /> P APPLICANT/SELLING NAME APPLICANT CONTACT NAME <br /> L <br /> I <br /> C MAILING ADDRESS APPLICANT PHONE Y WITH AREA CODE <br /> A <br /> T CI�TTY/n� I STATE ZIP CODE TYPE of APPLICATION <br /> (Closure, Instal Lation, etc.) <br /> TOTAL <br /> ANNUAL fACILI7Y FEE (Prior to January 1, 7991) = 2100.00 1986 1987 1988 1 1989 1 1990 <br /> A <br /> = /oo-ttoo $ Zoo 9Y05 <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XX =(xXX $ g1J2- <br /> E XXtooT loo V TANK FEE - $50.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> Y Tanks a _17— 1986 11987 11988 1989 11990 1991 11992 1993 1994 11995 1996 <br /> F (multiply x try fee for -z'/ <br /> A each year applicable) )O= xCCI I (Op /0p�3y&l r40 5d/OI3./o I 2 /5560 g00 <br /> C ,ll <br /> I TANK PENALTY FEES ASSESSED I xXxX I XXXX I I !OD I/dl7 370 V I 3'/D S t J(6 (yf <br /> L <br /> I STATE SURCHARGE = S56.00 each TANK (Deme every 5 years) See California H 3 S Code, See:ion 25287 <br /> T <br /> Y S Tanks Z- z 556.00 1988 through 1990 1991 through 1996 <br /> (Enter a c and year) <br /> I I //Z <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) I TANK I.D. x(s) <br /> L <br /> 01 CLOSURE FEE - $78.00/hour (3 hours ainimum/TANK) 4 TANK(s) X $234.00 = S <br /> S <br /> U TEMPORARY CLOSURE (Plan Review & Irssoections) TANK I.D. x(s) <br /> R <br /> E TEMPORARY CLOSURE FEE - S78.00/hour (3 hours minimLm/FACILtTY) I $234.00 minim S <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction (nspections)I TANK I.D. As) <br /> L <br /> A <br /> N PLAN CHECK FEE - $78.00/hour (8 hours ainimm/FACILITY) 5624.00 minimus S <br /> R REPAIR FEE (Lorkolan Review & Constrcrtion Insoeetiav) I TANK E.D. i(s) <br /> E <br /> P TANK LINING REPAIR FEE - 578.00/hour (3 hours minimm/TANK) x TANK(s) X 5234.00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) _ $234.00 minim m S <br /> R <br /> PIPING REPAIR FEE = $78.00/hour (3 haat mi nimum/FACI LITT) = 2234.00 minimum S <br /> NTRANSFER FEE = 520.00 UNAUTHORIZED0.ELEASE EVALUATION = $78.00/hr L <br /> S <br /> Cl CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE = S78.00/hr L <br /> -7791fz- 55935/ �� 5,& IJ `SCL5 35 I TOTAL ouE 2 �7 <br /> FOR OFFICE USE ONLY 35 ' <br /> SWEEPS At COMPUTER t I LOC CODE ]EST CODE AMOUNT .RECEIVED C4ECX :/CASH RECEIVED 3Y DATE RECEIVED i <br /> S <br /> EH 23 032 (REVISED 10-28-93) �'� iV 7 Page 11 I� /� <br />