Laserfiche WebLink
` 0 SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICE <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> • FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> A 940&RAI <br /> C - SITE PHONE # with AREA CODE <br /> IFACILITY ADDRESkw. <br /> I <br /> T CITY STATE ZIP CODE # of TANKS <br /> T q ZZ at SITE <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P <br /> L APPLICANT PHONE # WITH AREA CODE <br /> I MAILING ADDRESS <br /> C <br /> A <br /> STATE 21P CODE TYPE of APPLICATION <br /> N CITY <br /> T CLOSURE, INSTALLATION, etc. <br /> TOTAL <br /> A 1986 1987 1988 1989 1990 <br /> C <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 5 10 <br /> I <br /> V5170/TANK (after January 1, 1991) <br /> E TANK FEE = 550.00/TANK (prior to January 1,1991) <br /> F # Tanks 1986 1987 1988 1989 1990 1991 1992 1993 11996 1995 1996 <br /> A (multiply fee for S <br /> C each year applicable) D <br /> 1 <br /> L STATE SURCHARGE = 556.00 each TANK (Due every 5 years) See California X & S Code, Section 25287 <br /> I <br /> T # Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) / / 9 S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> C 77 <br /> L CLOSURE FEE = 553.00 per hour (3 hours minimum per TANK) # TANK(s) X 8'H4z,0 = R <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. #(s) <br /> R <br /> TEMPORARY CLOSURE FEE = 5750.00 each TANK # TANK(s) _ X 5750.00 = S <br /> P PLAN CHECK (Install. Plan Review 8 Construction Inspections) TANK I.D. #(S) <br /> L <br /> A S <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minimm per Facility) = $424.00 mini mum <br /> R . REPAIR FEE (workplan review 8 construction inspections) TANK I.O. #(s) <br /> E <br /> P TANK REPAIR FEE = 553.00 per hour (3 hours minimum/TANK) # TANK(s) X $159.00 = S <br /> A <br /> 1 $ <br /> R PIPING REPAIR FEE = 553.00 per hour (3 hour minimum per facility = $159.00) <br /> MTRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION = 553.00/hr $ <br /> I <br /> S <br /> C CONSULTATION FEE = 553.00/hr SAMPLING INSPECTION FEE = 553.00/hr 5 <br /> TOTAL DUE 5 <br /> OFFICE USE ONLY <br /> ................................................._......._...v.._. ............. <br /> " 0 �..GcOgISC173'E ` igC�)fi`fC�N CNcCK "/CASHram <br /> CcIEb > Ig �- x <br /> ��....... $.......f G.'. _�. .. ._�. .......... ..........��.......... <br /> 1...Y4. .f .. ... ...........' <br /> mzsz:rcassuazs,v ,xsszsazvzawca;x xxazs:.axwumcs .o�ossxzmx:.sx�rammua ac�vau�r�.mu�szsprsmswmsmmsmas <br /> EH 23 032 lREV 618/911 ft Pace 11 <br />