Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES Ida <br /> ENVIRONMENTAL HEALTH DIVISION <br /> IIn.ERGRCUND STORAGE TANK PROGRAM - FEE 4CRKSMEET <br /> FACILITY SITE NAME n <br /> yF �� G(� FACILITY CONTACT NAME <br /> C <br /> r <br /> I FACILITY ADDRESS SITE PHONE ? with AREA CODE <br /> (� <br /> T CITY y/�Y/' Com/f��, SSTT'ATTIE ZIIP CODE X of TANKS /� <br /> Y �i7 lJofO at SITE d :e ....,. .' :.. <br /> AAPPLICANT/BILLING NAME APPLICANT CONTACT NAME �� ?fin,✓ 3 S7 <br /> L �h G, ? n ,.-OCTu <br /> I MAILING ADDRESS AP LICANT PHONE X WITH AREA CODE <br /> N CITY /� $FATE ZIP CODE TY f APPLICATION <br /> T !/ `�. OSUR INSTALLATION, etc. <br /> jOTALC1986 1987 1988 1989 1990T ANNUAL FACILITY FEE (Prior to January 1, 1991) = S100.00 <br /> I <br /> V <br /> E TANK FEE = $50.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F X Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply X by fee for <br /> C each year applicable) S <br /> L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> f <br /> Ti Tanks z $56.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) <br /> S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) _ <br /> C <br /> L CLOSURE FEE = S53.00 per hour (3 hours minim per TANK) TANK(s) r X 5159.00 = s 75 .(7 U <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. k(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = S150.00 each TANK X TANK(s) X $150.00 = S <br /> P PLAN CHECK (Install. Plan Review b Construction Inspections) TANK I.D. X(s) <br /> L <br /> AlV PLAN CHECK FEE - S53.00 per hour (8 hours minim per Facility) = S424.00 minion $ <br /> R REPAIR FEE (workplan review 8 construction inspections) TANK I.D. x(s) <br /> E <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimum/TANK) 0 TANK(s) X 5159.00 = S <br /> A <br /> I <br /> R PIPING REPAIR FEE = $53.00 per hour (3 hour minimus per facility = $159.00) S <br /> M CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> S <br /> C FEE = $53.00/hr FEE = $53.00/hr FEE = S 53.00/hr <br /> TOTAL DUE 3 O�GI <br /> OFFICE USE ONLY <br /> ................................................ ............................................................................................................................................................................................................ <br /> A...m.Avee.w..we.b... _ _ <br /> ,s OrC` -bm(sy-C )�A A YU'°x E' "CA' "'�` "a' AAAA$ nr?¢s�mlWt'+,a"m <br /> w <br /> ww raw,rrw»arwuawrwrs»r�»w»wwrwr,r vw riKwosr»Ti_..•.•....•....• •.............. ...................................-......3 <br /> 1F W RLIt.YY AAA W BYYii}tYAfNtAA f.I.Vli�i.YNi W AINY W Asi W1t YfiAYlYA6A!DNfM.91tfSAM YY IAisi WlY e1i W W6YK SA0Y WiRWIi WtptAq'AA AAAAA atYi Ni ANKAIY WY ATMf wlYA,i <br /> EN 23 032 (REV 1/10/911 ft Pace 11 <br />