Laserfiche WebLink
• •SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES • <br /> ENVIRONMENTAL HEALTH DIVISION <br /> , UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> C 8P 11190 gllo'l031 le4lle <br /> I FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> L /a0(v E. a 209- 418-(0481 <br /> T CITYC' , L STATE ZIP CODE # of TANKS <br /> Y x-76-TVA CD, <br /> at SITE <br /> AA APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P RP D,14A. � -PWI �,wsen au. <br /> L b-40 t <br /> I MAILING ADDRESS APPLICANT PHONE # WITH ArA CODE <br /> Q30 <br /> N CITY STATE ZIP CCOE T APPLICATION <br /> T RpyOC Corda.�. 95�7t7 OSURE, INSTALLATION, etc. <br /> TOTAL <br /> A <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 <br /> 1 S <br /> V <br /> E TANK FEE = $50.00/TANK (prior to January 1,1991) S170 TANK (after January 1, 1991) <br /> F # Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multi ply # by fee for <br /> C each year applicable) s <br /> I <br /> L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 <br /> I <br /> T # Tanks X 556.00 1986 through 1990 1991 through 1996 <br /> Y (enter ;;Runt and year) <br /> E <br /> PERMANENT CLOSURE (Removal or Authorized Ctosure-in-Place) TANK I.D. #(s) <br /> C <br /> L CLOSURE FEE = S53.00 per hour (3 hours minimum per TANK) # TANK(s)_A— X $159.00 = $636 Q <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = $150.00 each TANK # TANK(s) X $150.00 = s <br /> P PLAN CHECK (Install. Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours mini mm per Facility) = S424.00 mini nun s <br /> R REPAIR FEE (workplan review & construction inspections) TANK 1.D. #(s) <br /> E <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimun/TANK) # TANK(s) X $159.00 = s <br /> A <br /> I <br /> R PIPING REPAIR FEE _ $53.00 per hour (3 hour minimum per facility = 5159.00) $ <br /> M CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> S <br /> C FEE = $53.00/hr FEE _ $53.00/hr FEE _ $ 53.00/hr <br /> TOTAL DUE s <br /> OFFICE USE ONLY <br /> w yr rw�.::w.v»x.....e.......e..e.r+w v»x.w x»rs»(ee..eee.z»z.....ue.m u.x.x.a ew x...r.s.x.•m..s»....w.e.x—.............s....n..m,.e......e....e.�...a..x....•.i <br /> a S c <br /> Y.......................... ....................... .................... ........................ .................................. ............................. .................................... ...........................................8 <br /> Yv rw•rrsr <br /> NA`/W1V 9B�fnYY%L k1Y1NAt4XNtAO 1RW f�]H[Y�RWf:W[f8{ANtY 84'•NtBM'RYM[Mfhi MATMMAIi YAL1t.YfA41Pi AlYfv4 WAifawf.09R WtM WiAYfMlat W MHtffOi¢IP.14RB4 W AY A4 PYtl4Mi <br /> EH 23 032 (REV 1/10/91) ft Paoe 11 <br />