Laserfiche WebLink
N JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> FAC t NAI(E FACILI(Y CONTACT HAASE . - .. <br /> ✓ , <br /> FACV a 4 SITE PHONE#WITH CODE <br /> "/�h <br /> aa9 333 STATE ZIP CODE #OF TAIMS AT SITE <br /> ., TT <br /> pa CA V <br /> APPLICANT8LL1W NAMEESTATEIN( <br /> - .APPLICANT CONTACT NAME - <br /> ELITE IV CONTRACT _ CARRIE HILLER <br /> APPLFCANT MAILING ADDRESS" APPLICANT PRONE#WITH AREA CODE <br /> 2535 .WIGWAM DRIVE ( 209 .461-6337 <br /> CITY ZIP CODE- CIRCLE WORK TO BE DONE_ <br /> "Siv�tCtON 95205 - -. _Ctosure Irnta9atwn Repav Retrofit . <br /> "ACIIVE FMAIIY <br /> 1998 - 1999. 2000 2001 . 2002 <br /> _ $500 FEE INCLUDES FACILITY FEE+1 TANK- .(SSm)xpw&4 <br /> {S125.PERYAW AFTER HRSTTANK " <br /> - - • TANK PETIALTYASSESSED <br /> TANK SURCHARGE $101 TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON M"ItIRY.IN A COPA PROGRAM=S17.5G/FAC41{Y $ !. <br /> i <br /> TANK ID#(s):. - _ CLOSURE FEE==9YTANK 7 aTA?,VSXS279= $ " <br /> TEMPORARY CLOSURE <br /> (Pian Review and kmpecfi s) <br /> TANK ID.II(s). TEIPORARY CLOSURE FEE=$2791 FACILITY . <br /> - O STALLATKMFPLAN.CHECK - - <br /> . (Plan Ct ec#and CmsN� - <br /> .� TAW IDa(s). _ PLAN CHECK FEE <br /> . _ REPAIR PLAN CHECK <br /> TANK ID s): - <br /> TANKRE TROFTT REPAIR FEE _$2791 FACILITY (use for mw&dng equ wp t spabudcets.tw*sumps.mist) <br /> PIPINGREPAIR FEE =$2791 FACILITY $ <br /> MISCELLANEOUS <br /> } TRANSFER FEE — $2p <br /> 'CONSULTATION FEE: =S 931 HOUR $ <br /> UNAUTHORt2ED RHEASE EVALUATION FEE . _ $931m" <br /> - ... $ '• <br /> SAMPLING 94SPECTIOM FEE = S931 HOUR <br /> 'ALL FESS"ARE BASED ON THE$93 HOURLY RATE MMUETHAT EXCEED FEES PAIDWLLC BE M 1,E TO APPUCAKr -- <br /> OFFICE USE ONLY <br /> -SERVICE REOUESf# FACIAYID jCHECK# ' - rRELHVED8Y OA1ERECEBAD I <br />