Laserfiche WebLink
SAN JGAOUIM COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH OIVSION <br /> A, "VOEMGROUNO STORAGE TANK PROGRAM - FEE WORKSHF' <br /> S FAC LITY SITE NAME FACIY..+Cu.i Ci NAPpE <br /> lt(tl,t( vo�5 I dO�iN �S{ <br /> 'E FACILITY ADORES - SITE PHONE 4 with AREA CODE-14 <br /> CITY STATE ZIP CODE + of TANKS <br /> I at SITE <br /> P AP/PL�ICA/N�T�/B� j't <br /> ILLING NAME APPLICANT I:ONTANAME <br /> I7�A/lx�V I txi( L19Cj1 <br /> C MAILING AOORESS APPLICANT PHONE A WITH AREA CODE <br /> N /zr7 S . 2(q) C7,1-46f3 <br /> T <br /> STATE ZIP CODE TYPE of APPLICATION <br /> G,�TY� rV (C(osure, Installation, etc.) Fx�D✓� <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5I00.00 I <br /> A XXXX I %XXX xxxx ' xxxx I xxxx 5 %XXXXXXX <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicab(e) xxxx XXXx I xxxx I xxxx i xxxx S xX%%XXXX i <br /> Yi TANK FEE = 550.00/TANK (Prior to January 1,1991) I 5170/TANK Ufter January t, 1991) <br /> E <br /> Tanks 1988 1 1989 11990 1991 11992 1993 1 1994 � 1995 11995 11997 11998 <br /> F (multiply by fee for <br /> - <br /> A each year applicable) XXXX I xxxx 1 XXXX I xxxx IXXxx I i I I. I S _ <br /> C I 11 <br /> I TANK PENALTY FEES ASSESSED I XXXX I XX%% XX%X I XXXX IXx%X I 5 <br /> L <br /> I STATE SURCHARGE FCR NEW FACILITIES ONLY=518.50 5 <br /> T <br /> Y 9 Tanks_ x 58.00 1988 through 1993 (555) 1993 ;hrau9h 1997 (556)1 1998 1 f <br /> SURCHARGE FOR 1998 %XXXX%XXXXXXX%xxxxxxxxxxxxx 1 ' XXxxxxxxxxx%%xxxxxxxxxx 1 S <br /> CI vERMANENT CLOSURE (Removal or Authorized Closure-in-Place) I TANK E.G. #(S) I ([1 <br /> L <br /> 0 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) I X TANK(s) ".i % 574.00 <br /> 5. <br /> UI TEMPORARY CLOSURE (Plan Review & Inspections) <br /> LANK E.D. =(s) <br /> ct <br /> R, { S <br /> EI TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/FACILITY) I 5234.00 ,minimum <br /> P INSTALLATION PLAN CHECX (Plan Review 3 fanstructian Inspections) TANK L.D. :(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = S78.00/hour (8 hours minimum/FACILITY) = 5624.00 minimum <br /> R REPAIR FEE (Workplan Review & Construction InspectIOMS) I TANK I.O. S(s) <br /> E = 5 <br /> P TANK LINING REPAIR FEE = 578.00/hour CS hours minimum/TANK) I ' % TANK(s) __ x 1234.00 <br /> A ; <br /> I TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = 5234.00 minimum <br /> R S <br /> PIPING REPAIR FEE = 378.00/1hour (3 hours minimm/FACILITY) = 5234.00 minimum <br /> N TRANSFER FEE = 527.00 I UNAUTHORIZED RELEASE EVALUATION = 578.00/hr I I 1 S <br /> [ � I <br /> 5S <br /> C CONSULTATION FEE = 578.00/hr I I SAMPLING IHSPERION Fc ' 578.00/hr I I <br /> TOTAL DUE <br /> FOR OFFICE USE ONLYXSESISs <br /> - <br /> SWEEPS <br /> COMPUTER = I LOC CCOE I 0[57 CCOE I AMOUNT .RECEIVED I CHECK 3/CASH I RECEIVED 3Y I GATE RECEIVED <br /> EH 23 032 (REVISED 1-12-981 <br /> f <br />