Laserfiche WebLink
-� <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALiN DIVSIpI <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> SI FACILITY SITE NAME <br /> I <br /> FACILITY CONTACT NAME <br /> T S c, J I y CY �� (.. <br /> E FACILITY ADDRESS <br /> 3 I ' - QI0 1 S E PNON # v/1�th AREA CODE <br /> CITY M �I <br /> ASTAYE ZIP CODE # of TANKS 3 13V- <br /> P CA ,�� at SITE <br /> P APPLICANT/BILLING NAME L � �CY Cts <br /> APPLICANT CONTAC NAME <br /> L c9 Y✓1 <br /> ^ <br /> L MAILING ADDRESSr <br /> N ` )lal C ) �jl0 PLICANT PHONE # WITH AREA CODE <br /> T CITY <br /> STATE pZIP CODE TYPE of APPLI <br /> C -V - 7 yS�j (Closure nstallatio , etc.) <br /> TOTAL <br /> A ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 1986 1987 1988 1989 1990 <br /> C XXXX XXX)( $ <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XXXX <br /> I S <br /> V TANK FEE = 550.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> 9 Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 :T <br /> F (multiply # by fee for <br /> A each year applicable) XXXX XXXX S <br /> C <br /> I TANK PENALTY FEES ASSESSED XXXX XXXX 5 <br /> L <br /> I STATE SURCHARGE - $56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> T N�-237 1 <br /> Y # Tanks x 556.00 1988 through 1990 1991 through 1996 7Y <br /> (Enter amount and year) �} <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> L <br /> 0 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s)_ X 5234.00 = S <br /> S <br /> U TEMPORARY CLOSURE (Plan Review 8 Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = 578.00/hour (3 hours minimum/FACILITY) 5234.00 minimum S <br /> P INSTALLATION PLAN CHECK (Plan Review 8 Construction Inspections) TANK I.D. #(s) 2 <br /> L <br /> A <br /> N PLAN CHECK FEE = 578.00/hour (8 hours minimm/FACILITY) = 5624.00 minimum S 6 2lq <br /> R REPAIR FEE (Workplan Review 8 Construction Inspections) TANK I.D. #(s) <br /> E, <br /> P TANK LINING REPAIR FEE = 578.001hour (3 hours minimm/TANK) # TANK(s) X 5234.00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) = $234.00 minimum $ <br /> R <br /> PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) = 5234.00 minimum $ <br /> M TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION = 578.00/hr S <br /> I <br /> S <br /> C CONSULTATION FEE = 578.00/hr SAMPLING INSPECTION FEE = 578.00/hr S <br /> TOTAL DUE <br /> FOR OFFICE USE ONLY <br /> SWEEPS # COMPUTER # LOC CODE DIS CODE AMOUNT RECEIVED CNECK #/CASH I RECEIVED BY I DATE RECEIVED 3 <br /> EH 23 032 (REVISED 10-28-93) "/ <br />