Laserfiche WebLink
' SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALI .VSION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME I FACILITY CONTACT NAME <br /> f'7 <br /> E FACILITY ADDRESS SITE PHONE 0 with AREA CODE <br /> CITY I STATE ZIP CODE I � of TANKS <br /> I ^ ,I ,�is•��� ' at SITE <br /> A 0 IC: 7 <br /> P APPLIC NT CONTACT NAME <br /> APPLICAN BILLING SME I rj �� ✓'�� �� <br /> I APPLICANT PHONE WITH AREA CODE <br /> C MA ING <br /> A �v E 7 Ci <br /> N STATEI ZIP CODE TYPE of APPLICATION <br /> T CITY ( .(Closure, installation, etc.) <br /> TOTAL <br /> 1986 � 1987 11988 � 1989 11990 <br /> ANNUAL FACILITY FEE (Prior ;o January 1, 1991) = 5100.00I XXXX I XXXX I XXXX i XXXX I XXXX S XXXXXXXX <br /> A ' <br /> C ,(If applicable) <br /> XXXX i XXXX I XXXX XXXX I XXXX S XXXXXXXX <br /> T FACILITY PENALTY FEES ASSESSED <br /> I � S170/TANK (After January 1, 1991) <br /> Y FTANK FEE = 350.70/7ANK (Prior to January i,1991) <br /> Ei Tanks = i 1988 1989 1990 1991 1992 11993 1994 1995 11996 1997 , 1998 <br /> FI (multiply K cy fee for <br /> Al each year acplicable) , XXXX XXXX XXXX XXXX XXXX <br /> C' <br /> I) TANK PENALTY FEES ASSESSED XXXX j XXXX I XXXX XXXX 'XXXX <br /> L' I <br /> II STATE SURCHARGE FOR NEW FACILITIES ONLY=$18.50 t <br /> T 1. I 1993 hrou h 1997 CS56)1 1998 <br /> Y » Tanks x 38.00 1988 through 1993 (556) � t' 9 <br /> SURCHARGE FOR 1998 <br /> I xxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxx 3 <br /> C; PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. »(S) <br /> L' T TANK(s) X 5234.OD <br /> OI CLOSURE FEE = 378.00/hour (3 hours minimum/TANK) <br /> S TANK I.D. »(5) <br /> r <br /> Ul TEMPORARY CLOSURE (Plan Review & nspections) <br /> R' 3 <br /> El TEMPORARY CLOSURE FEE = 578.00/hour (3 hours minimum/FACILITY) I 3234.00 minimum i <br /> PI INSTALL?TICN PLAN CHECK (Plan Review & Construction inspections) TANK I.D. »(S) <br /> L� <br /> Al = 5624.00 minimum S <br /> NPLAN CHECK FEE = 578.00/hour (8 hours minimum/FACILITY) <br /> R1 REPAIR FEE (Workp(an Review & Construction Inspections) I TANK I.J. »(S) <br /> E, t TANK(s) X 5234.00 = 1 S <br /> P TANK L:41116 REPAIR FEE = 578.00/hour (3 hours minimum/TANK) <br /> A <br /> r _ <br /> I1 TANK RETROFIT REPAIR FEE = ;78.00/hour (3 hours min./FACILITY) _ 5234.00 minimum <br /> R, PIPING REPAIR FEE = 578.00/hour (3 hours :minimum/FACILITY) = 5234.00 minimum 3 <br /> M TRANSFER "__ <br /> -- = 520,00 + j UNAUTHORIZED RELEASE EVALUATION = 578.00/hr <br /> � <br /> I ; <br /> S -- I S <br /> C' CONSULTATION FZ= = 578.00/hr I SAMPLING INSPECTION FEE = 578.00/hr 1 <br /> TOTAL DUE S <br /> FOR OFFICE USE ONLY <br /> _.....................................::::::::::::•:•:::::::::::::::::::::::::::::====a-:s:ai:--:-:-:a¢i:-i:=isiisi:iii::::i:i:--?'€It:::s::' ::::t:::ait:t:i:t: . . .. <br /> .............................................. <br /> eii:i:i:ii�iiiiiii�iii iiii�ci_:_:::::::::_�:::�::::::::::�:::::::::: ...-. ^ ., : 'ATE E ^='� F. <br /> ........ <br /> crc <br /> SWEEPS I CC.mPUTER LOC CODE f DIST CCDE I MOUNT R�- IVED ` CHECK »/CASH I RE_c:VcD �Y - REQ- -D <br /> 13 <br /> EH 23 032 (REVISED 1-12-98) <br />