REMOVAL_1999 - Laserfiche WebLink

Home Browse Search

SAN JOAOUIN CLIC HEALTH SERVICES - ENVIRONMENTAL HEA%LVSION • UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET S FACILITY SITE NAME p/ FACILITY CONTACT NAME T L 0 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X SZ34.00 = s-762•�.�' 'E FACILITY ADDRESS SITE PHONE # with AREA CODE i A U CITY STATE ZIP CODE # of TANKS A at SITE I 1987 11988 11989 P 1990 R P APPLICANT/BILLING NAME APPLICANT CONTACT NAME L TEMPORARY CLOSURE FEE = S78.00/hour (3 hours mini"/FACILITY) $234.00 minimum S I A C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE A xxxx%X%X Xx%X xxxx S xxxxxxxx N T CITY STATE ZIP CODE I TYPE of APPLICATION (Closure, Installation, etc.) C PERMANENT CLOSURE (Removal or Authorized Ctosure-in-Place) I TANK 1.0. #(s) L 0 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X SZ34.00 = s-762•�.�' S TOTAL A U TEMPORARY CLOSURE (PLan Review 8 Inspections) 1986 1987 11988 11989 1990 R ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 E TEMPORARY CLOSURE FEE = S78.00/hour (3 hours mini"/FACILITY) $234.00 minimum S A xxxx xxxx%X%X Xx%X xxxx S xxxxxxxx C T FACILITY PENALTY FEES ASSESSED (If Applicable) xxxx xxxx xxxx xxxx xxxx 5 %xxxxxxx I V TANK FEE = S50.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) E 9 Tanks = 1988 1989 1990 1991 11992 1993 1 1994 1995 11996 1997 1998 F (multiply # by fee for xxxx xxxx xxxx xxxx XXXXI S A each year applicable) C I TANK PENALTY FE"cS ASSESSED I XXXX 1 xxxx xxxx xxxx xxxx I S L I STATE SURCHARGE FOR NEW FACILITIES ONLY=518.50 S T Y # Tanks x 58.00 1988 through 1993 (S56) 1993 through 1997 ($56) 1998 SURCHARGE FOR 1998 xxxxxxxxxxxxxxxxxxxXXXX%XXX xxxxXxxxxxxxxxxxxxxxxxx S C PERMANENT CLOSURE (Removal or Authorized Ctosure-in-Place) I TANK 1.0. #(s) L 0 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X SZ34.00 = s-762•�.�' S _ A U TEMPORARY CLOSURE (PLan Review 8 Inspections) TANK I.D. #(s) S R E TEMPORARY CLOSURE FEE = S78.00/hour (3 hours mini"/FACILITY) $234.00 minimum S INSTALLATION PLAN CHECK (Plan Review 8 Construction Inspections) TANK I.D. #(s) PLAN CHECK FEE = S78.00/hour (8 hours minirm /FACILITY) = 5624.00 minimum 5 R REPAIR FEE (Workplan Review 8 Construction Inspections)I TANK D. #(s) E _ _ __ _ -_ --___ _ - - -- ............................. .... .............. .::::::::_:: SWEEPS # COMPUTER # P TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = 5 _ A ......................... ........... ........ .....:: I TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min -/FACILITY) = $234-00 minimum S R PIPING REPAIR FEE = 578.00/hour (3 hours minimwn/FACILITY) = $234.00 minimum S I TRANSFER FEE = S20.00 CONSULTATION FEE = S78.00/hr FOR OFFICE USE ONLY UNAUTHORIZED RELEASE EVALUATION = $78.00/hr I S I 1 SAMPLING INSPECTION FEE = $78.00/hr I S TOTAL DUE 1 4 :x :: �c„ :cv::`__.—;:—:—:.---_-___ .-:::::::::::::::._:::::::::..._..._..:.:........:...._........_._..-::.........._......,..........__:_:.._.._.._...._...._.._....__......_._._.:...._.._...._....._............._:_:__::::.::.:-:::._:.__:..__.__:__...:.._:::..::-:._::.._::�:_:..:.__.—_ ...,,....._:..._:rs::::c:a ur::a: _:::_:::::::::_._:_�...._� _ _ __ _ -_ --___ _ - - -- ............................. .... .............. .::::::::_:: SWEEPS # COMPUTER # LOC CODE DIST CODE CEIVED AMOUNT RECEIVED I CHECK #/CASH RECEIVED BY GATE RECEIVED is S ......................... ........... ........ .....:: ........_.........._.............:::._....._-......:_;._ _...........__..._....... __.......__....._.._.._..:...,_.;.............__..._ ..... ......... -- S:d Fu JX nil CRFVISFD 1-12-98)