Laserfiche WebLink
%/27A2001 13:57 209468 FIFTH FLOOR PAGE 04 <br />t SAN .IOAQUIN COUNTY PUBLIC HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION <br />UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br />6 <br />FACILITY NAME <br />FACILITY CONTACT NAME <br />& U 1 K57VP <br />M/KE 1<'44,vEto e <br />FACILITY ADDRESS <br />3555 W. MM 6L LA7,/E <br />SITE PHONE # WITH AREA CODE <br />510 <br />CITY <br />CODE <br />ZIP CODE <br /># OF TANKS AT SITE <br />r--� <br />5roc�cToh/ <br />ESTATE <br />ca <br />95aoy <br />APPLICANT BILLING NAME <br />'APPLICANT CONTACT NAME <br />TR/Aa/fstE &xlV1,eO,c/,oqC-A[7x►G, Aid- Pq �L* YE�lCES <br />APPUCANT MAILING ADDRESS <br />SSS W �t�,ei3.9�1G �t-VA • <br />APPLICANT PHONE # WITH AREA CODE <br />8l fl 840-70.20 <br />CITY <br />STATEZIP <br />CODE <br />CIRCLE WORK TO BE DONE: <br />Closure Installation Repair Retrofit <br />Uel fjll iii K <br />_L <br />9, 5nS <br />1996-1999 2000 2001 <br />$500 FEE INCLUOES FACILITY FEE + 1 TANK (S170) X (.-tanks) X (# of years applicable) <br />$125 PER TANK AFTER FIRST TANK I iS <br />TANK PENALTY ASSESSED $ <br />TANK SURCHARGE = S8 /TANK S <br />STATE SURCHARGE FOR FACIUTIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM = SIO / FACILITY <br />Plan Check and Construction ins coons <br />TANK ID # {5) : PLAN CHECK FEE _ $696 / FACILITY <br />REPAIR PLAN CHECK <br />TANK 1D # 5 � <br />TANK LINING REPAIR FEE = $261 f TANK # TANKS X $201 <br />5 2to1 <br />TANK RETROFIT REPAIR FEE = $261 /FACILITY i <br />PIPING REPAIR FEE = $261 / FACILITY <br />