Laserfiche WebLink
TRANSFER FEE = S 20 <br />CONSULTATION FEE = $ 891 HOUR <br />UNAUTHORIZED RELEASE EVALUATION FEE = S 891 HOUR <br />SAMPLING INSPECTION FEE = $ 891 HOUR <br />ALL FEES ARE BASED ON THE $E9 HOURLY RATE. TIME THAT EXCEE <br />OFFICE USE ONLY <br />SERVICE REQUEST # FACILITY ID AMOUNT REC <br />SR <br />FEES PAID WILL, BE BILLED TO APPLICANT_ <br />ED CHECK ti RECEIVED BY DATE RECEJVED <br />SAN JOAQ LINTY PUBLIC <br />HEPALTH SERVICES-ENVIRO TAL HEALTH DIVISION <br />UNDER UND STORArE TANK PROGRAM FEE WORKSHEET <br />FACILITY NAME <br />FACILITY CONTACT NAME <br />�rr, [ye 5 <br />Er 1 <br />FACILITY ADDRESS <br />% e— <br />SITE PHONE # WITH AREA CODE <br />Li b �e <br />�{ _2gso <br />CITY <br />STATE ZIP CODE # OF TANKS AT SITE <br />C) c.l(,-�-n <br />CA S 5— <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />\0 <`a o (-' <br />�e �o <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />S [t <br />CITY STATE <br />ZIP CODE CIRCLE WORK TO SF DONE. <br />�C) L �� <br />+� Q Closure Installation <br />Repair Retrofit <br />ACTIVE FACILITY <br />$500 EEE INCLUDES FACILITY FEE + 1 TANK <br />1996-1999 <br />($170) X(n tanks) X (a of years applicable) <br />2000 <br />2001 <br />$125 PER TANK AFTER FIRST TANK <br />$ <br />I TANK PENALTY ASSESSED <br />TANK SURCI TARGE = $81 TANK <br />$ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM = $101 FACILITY <br />$ <br />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # is): <br />TEMPORARY CLOSURE <br />CLOSURE FEE =$2671 TANK #TANKS X $267 = <br />$ <br />(Plan Review and Inspections) <br />TANK ID # (s): <br />TEMPORARY CLOSURE FEE _ $2671 FACILITY <br />$ <br />INSTALLATION PLAN CHECK <br />Plan Check and Construcbon lns exons <br />TANK ID # (s) : <br />PLAN CHECK FEE _ $712 1 FACILITY <br />$ <br />REPAIR PLAN CHECK <br />TANK ID # (s) : <br />TANK LINING REPAIR FEE _ $2671 TANK <br /># TANKS X $267 = <br />$ <br />TANK RETROFIT REPAIR FEE = $2671 FACILITY <br />$ �� <br />PIPING REPAIR FEE = $2671 FACILITY <br />$ <br />TRANSFER FEE = S 20 <br />CONSULTATION FEE = $ 891 HOUR <br />UNAUTHORIZED RELEASE EVALUATION FEE = S 891 HOUR <br />SAMPLING INSPECTION FEE = $ 891 HOUR <br />ALL FEES ARE BASED ON THE $E9 HOURLY RATE. TIME THAT EXCEE <br />OFFICE USE ONLY <br />SERVICE REQUEST # FACILITY ID AMOUNT REC <br />SR <br />FEES PAID WILL, BE BILLED TO APPLICANT_ <br />ED CHECK ti RECEIVED BY DATE RECEJVED <br />