Laserfiche WebLink
V <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET s <br /> FACILITY SITE NAME FACILITY CONTACT NAVE^,}r .5 1991 <br /> F <br /> ^ <br /> C ' �[�G <br /> I FACILITY ADDRESS SITE PHONE # u { ERVICE <br /> STATE ZIP COOE # of TANKS <br /> YCITY y -D I CA 7' V C) at SITE <br /> A APPLICANT/BILLING NAME C 'A-iPPLICANT CONTACT NAME <br /> P sJ I <br /> P U N N-Y ?f,�TE i1 <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE # WITH-AREA CODE <br /> C <br /> A <br /> N CITY STATE ZIP CODE APPLICATION <br /> T Cp^ 952_4() CLOSU INSTALLATION, etc. <br /> 7 TOTAL <br /> A <br /> { 1986 1987 1488 ' 1984 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 <br /> s <br /> V <br /> E TANK FEE _ $50.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F # Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply # by fee for <br /> C each year applicable) $ <br /> I <br /> L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> i # Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) <br /> $ <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> G <br /> L CLOSURE FEE $53.00 per hour (3 hours minimum per TANK) # TANK(s)�_ X $159.00 = _FS <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 = $150.00 each TANK # TANK(s) X $150.00 = $ <br /> P PLAN CHECK (Install. Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - S53.00 per hour (8 hours minimum per Facility) _ $424.00 minivan $ <br /> R REPAIR TANK I.D. #(s) <br /> E <br /> P TANK REPAIR FEE = S53.00 per hour (3 hours minimum/TANK) # TANK(s) X $159.00 = S <br /> A <br /> 1 - <br /> R PIPING REPAIR REVIEW $ CONSTRUCTION = S53.00 per hour (3 hour minimum per facility = S159.00) S <br /> M CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> S <br /> C FEE = S53.00/hr FEE = $53.00/hr FEE = S 53.00/hr <br /> TOTAL DUE S 1521 <br /> OFFICE USE ONLY <br /> ................................................................................................................ <br /> MwIY,.Oz,YA4xm%Ootw ree.muaea 96oP leeP Jookkei�'.aalePxoo x0.YO.iSP'OQG/A x{S�M-:Cr'C4 J7K a �•. t 3 r r svt•Y.a ^c uo:exte xoe xna sa.xe�xnoee ze.Aawisua�xwm�xows wa�� #i S$ <br /> to <br /> » awcEr� `ac'"co>) DIST ccz) """"aIcuNrReVD exEcx R/cASH`" Rc�Ii BY `d �1° E 1� z g <br /> l <br /> tt��pplIa ....23 <br /> a...lfX. J 5 <br /> YoO aeeaa�%NXpb>x0Y%W%p011 M00 JOV0�%mINIAP:KO:MaFf.w„O b6:c:[M:KS:tIXM"M vvi+W:tih Y+ M O C'.:tl+a:tcb.f+b[0x+9[Y`9W10016�%9O%O�imu�i�i��fV�soaef fotM%Y�vw nM M00a9�fai <br /> �1Af 2Ulf6fti%aYCl, :�tllff�SlbY Ri71 RySV6f�l SA'.�>l. >7b:TS A:Y::.....:.�f::.r.'tLM::Jd:;JfK:;.......:..4.,.s..:...•.............r..,.......•........::f:tvi 9:`:ai:•if;...JF�:,,.Y.":YCd dtY m3tmf ttrsGs��Gs�%>USf �i»%;ftL'y5 r7�f$�% <br />