Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVSION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> Si FACILITY 'TE NAME I FACI I CONTACT NAME: <br /> TI I <br /> EI FACILITYDRES <br /> &' /y ___ SIT PHOWE with AREA CODE <br /> / 3/7 �_/iY' // IOy <br /> z _ <br /> CITY I TATE Z CODE 9 of TANKS <br /> PI at SITE <br /> AP( <br /> ICPT T N i <br /> I i 1 <br /> Ci, MAILING ADD APPLICANT PHONE » W I h AREA CME <br /> Al <br /> TI C.T (TATE! ZIP CODE a I TYPE of APPLICATION <br /> (Closure, Instaiiation, etc.) <br /> TOTAL <br /> E ; 1986 1 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January i, 1991) = 5100.00 <br /> ACI XXXX I XXXX i XXXX I XXXX I XXXX S XXXXXXXX <br /> 9o i i T' FACILITY PENALTY FEES ASSESSED (If Appiicable) XXXX I XXXX j XXXX XXXX XXXX 1 S XXXXXXXX <br /> s 1 <br /> V; TANK FEE = S50.00/TANK (Prior to January 1,1991) S170/TANK (After January 1, 1991) 1 <br /> Tanks = 1987 11988 1989 1990 1991 1492 <br /> 1993 11494 1995 1996 i 7947 <br /> I F; (muI io.ly r by fee for I <br /> A each year applicable) ' XXXX XXXX i XXXX I XXXX (XXXX I I 1 5 <br /> s C. 1 F <br /> i I TANK PENALTY FEES ASSESSED XXXX XXXX XXXX I XXXX iXXXX j O S <br /> E L` <br /> Ij STATE SURCHARGE FOR NEW FACILITIES ONLY = S18-50 �S <br /> T' <br /> Y » Tanks x S8.00 ! 1988 through 1990 (S56) 1991 through 1996 (S56) 1997 3 <br /> O i <br /> fi SURCHARGE =0R 1997 I XXXXXXXXXXXXXXXXXXXXXXXXXXX � XXXXXXXXXXXXXXXXXXXXXXX � � S , <br /> CI PERMANENT CLOSURE (Removal or Authorized Closure-in-Ptace) I TANK I.D. T(s) <br /> L - ; <br /> OI CLOSURE =_E _ 578.00/hour (3 hours minimum/TANK) � » TANK(s) X 5234.00 � S <br /> S, <br /> I <br /> UI TEMPORARY CLOSURE (Plan Review & Inspections) I TANK I.D. »(s) <br /> R' <br /> EEj TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/FACILITY) 5234.00 minimum S <br /> PI INSTALLATION PLAN CHECK (Plan Review & Construction Inspections)I TANK I.D. »(S) <br /> L <br /> Al <br /> i <br /> NI PLAN CHECK FEE: = 578.00/hour (8 hours minimum/FACILITY) = 5624.00 minimus S <br /> R REPAIR FEE (Workplan Review & Construction Inspections) i TANK I.D. »(s) <br /> E <br /> PI TANK LINING REPAIR FEE = S78-00/hour (3 hours minimum/TANK) TANK(s) X 5234.00 = S <br /> A <br /> I1 TANK RETROFIT R=_PAIR FEE = S78.00/hour (3 hours min./FACILITY) = SZ34.00 minimum S <br /> RI _ m <br /> PIPING REPAIR FEE = S78-00/hour (3 hours minimum/FACILITY) S234-00 minimus S <br /> M) TRANSFER FEE = 520.00I UNAUTHORIZED RELEASE EVALUATION = S78.00/hr I I S <br /> S i— I I i 1 <br /> C! CONSULTATION FE_ = S78.00/hr , I SAMPLING INSPECTION FEE = S78.00/hr I S <br /> TOTAL DUE S C9 31 <br /> OFFICE USE ONLY <br /> IUEEPS » COMPUTER » I LOC CODE I DIST CODE I AMOUNT RECEIVED I CHECK w/CASH I RECEIVED 3Y I DATE RECEIVED =_ <br /> - S �. <br />