Laserfiche WebLink
JOAQUIN LOCAL HEALTHI%STRICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> F FACILITY/SITE NAME <br /> A FACILITY CONTACT NAME <br /> , <br /> C 0 2 <br /> 1 r rr rr r oe S c7� <br /> L STREET ADDRESS SITE PHONE I (with Area Code) <br /> T <br /> Y CITY STATE IIP CODE I of TANK'S <br /> A APPLICANT/BILLING NAME at Site P APPLICANT CONTACT NAME <br /> � � S C1/3 11-/C-1c <br /> I MAILING ADDRESS APPLICANT PHONE I (with Area Code) <br /> C -5 <br /> A <br /> CITY <br /> T ATE IIP CODE TYPE of APPLICATION <br /> <} ;Yy (Closure, Installation, etc.) <br /> FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR —� <br /> A TOTAL <br /> C 198619 <br /> T 01 1988 1383 <br /> i — <br /> E TANK FEE = 150.00 each TANK <br /> F I Tanks x $50.40 1986 1987 1388 1983 <br /> A ................ ................ <br /> (sultrpTy I by fee for <br /> IL STATE SURCHARGE _ $56.00 each TANK (see CA HEALTH Q SAFETY CODE Sec 25287 for applicability) - <br /> [ I <br /> T I Tanks �x 156.00 1986 1387 1988 1939 <br /> Y (enter aaount and year) <br /> TWERMANEENTCLOSURE (Removal or Closure-in-place)LOSUR $90.00 each TANK <br /> I Tanks x $10.00` �_`� <br /> IA TEMPORARY CLOSURE (Only allowed one tije for up to two years) <br /> E <br /> TEMPORARY CLOSURE FEE _ $80.00 each TANK <br /> I Tanks ___ x 180,40 y <br /> P PLAN CHECK (Installation or Repair) J <br /> L <br /> A <br /> N PLAN CHECK FEE = $30.00 each SUBMISSION/RESUBMISSION <br /> REPAIR <br /> R <br /> E-TANK REPAIR FEE _ $110.00 each TANK <br /> P I Tanks x $110.40 ; <br /> A - <br /> I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, aini�aua one hour to be paid on plan subaittal) <br /> R <br /> �UNAUTHORIlED RELEASE EVALUATION CONSTRUCTION <br /> When applicable) IN5PECTION SAMPLING <br /> INSPECTION <br /> FSE _ $34.00/hr FEE = $35.00/hr <br /> . FEE = 13J.04/hr y <br /> $ �r/ <br /> aFFrcF USE ONLY TOTAL DUE <br /> •. _ - ! try e { y�„[y; a. aN y•t:r;} <br /> SWEEPS I COMP I ILOC CODEDIST CODE AMOUNT DUE I AMOUNT RCVD CHECK I/CASH RCVO BY DATE RECEIVED PERMIT I <br /> it - -------- <br /> _ry(....`7.tw^'1..�1+aYf,, <br />