Laserfiche WebLink
�9 JOACLIIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F Don Palin CPM <br /> A Boettcher Western Properties 111, Ltd. g� <br /> SITE PHONE 0 with AREA CODE <br /> 1 FACILITY ADDRESS N/A <br /> L 4555 N. Pershing Ave. <br /> 1 STATE ZIP CODE N of TANKS <br /> T CITY Ca 95207 at SITE 3 <br /> Y Stockton, <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> PDon Pelin CPM <br /> P Boettcher Western Properties 111 , Ltd. g� <br /> L APPLICANT FHON Uf WIT AR CCOE <br /> I MAILING ADDRESS 850 W. March Ln. {209473- 99 <br /> C <br /> A STATE ZIP CGDE TYPE of APPLICATION <br /> T CITY Si;oc4�ton, Ca. 95207 CLOSURE, INSTALLATION, etc-Removal <br /> TOTAL <br /> A 1986 1987 1988 1989 1990 <br /> C <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) ■ $100.00 3 <br /> 1 <br /> V !170/TANK (after January 1, 1991) <br /> E TANK FEE a 350.00/TANK (pylar to January 1,1991) <br /> F S Tanks 1986 1987 1988 1989 1990 1991 1992 1993 1994 1 1995 1996 <br /> A (multiply k by fee for $ <br /> C each year applicable) <br /> I <br /> L STATE SURCHARGE 356.00 each TANK (Due every 5 years) See California HRS Code, Seetlon 25287 <br /> I <br /> T UI Tanks x 156.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) f <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in•Place) TANK I.D. N(s) <br /> C <br /> L CLOSURE FEE R $53.00 per hour (3 hours minimum per TANK) a/ TANK(s)^ x (159.00 $ 4 77,a� <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/Inspections) TANK I.D. d(s) <br /> R a 3 <br /> E TEMPORARY CLOSURE FEE a $150.00 each TANK K TANK(s) % f150.QQ <br /> P PLAN CHECK (Irstatl. Plan Review UI Construction inspections) TANK I.D. R(s) <br /> L <br /> Ac $424.00 minimus $ <br /> N PLAN CHECK FEE - $53.00 per hazer (8 hours minimum per Faculty) <br /> R REPAIR FEE (workplan review b construction Inspections) YANK I.D. R(s) <br /> E $ <br /> P TANK REPAIR FEE = 153.00 per hour (3 hours mfnimum/TAHK) 3 TANK(s) X $159.00 <br /> A <br /> If <br /> R PIPING REPAIR FEE a 353.00 per hour (3 hour minimum per facility a $159.00) <br /> H CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> ' S <br /> C FEE = 353.00/hr FEE = $53.00/hr FEE = f 53.00/hr <br /> TOTAL DUE S <br /> OFFICE USE ONLY ;I <br /> ............»..» <br /> wwewd•.+.w}»�Ew'S�w.e..lw�.R...... .... �.t..M._»»................ <br /> w wwwww yw <br /> �: �w <br /> •� <br /> / rrer <br /> y <br /> • .•••••••••• ��.. wry ,w r.r <br /> » - <br /> mwv <br /> rww.•w..wwwMyr.wr.aw.....w <br /> M=M'1�MMMMI!WMMMMMMM:IMM!AtttMMR Mei 1p�M 1MtMMM Mr Mr MyMM Mt MMM MtlrlAIMM Mtfir MMMMt MYMi IMM MrM MM IAAAit MM AIM AUMt/lit McMM MMtMMIUM WWM <br /> MM MM MM MWlGI1MtM MAIM » <br /> EN 23 032 (REV 1/10/91) it Pace 1 1 <br />