Laserfiche WebLink
Si JOAQUIN LOCAL HEALTH STRICT <br /> � <br /> F FACILITY/SITE NAME <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE VORKSHEET �_\'- <br /> k FACILITY CONTACT HAVE <br /> t <br /> L STREET ADDRESS SITE PHONE 1 <br /> I YITR ARCA COOK <br /> r <br /> Y CITY STAT .ZIP CODE I of Tanks <br /> C` at Site <br /> A APFLICANTraILLING NA E <br /> P APPLICANT CONTACT ME <br /> ii� <br /> I MAIL ADDRESS ^ ` APPL NT P DNE 1 <br /> MITM ARCA COOL <br /> N CITY d <br /> T / , STAT iIP'CODE TYPE f APPLICATION <br /> c�o�uwC. IN�YAILArION� [Tc. <br /> FACILITY FEE = $100.00 each SITE ADDRESS per YEAR <br /> A TOTAL <br /> T <br /> T 1906 1937 1908 350? <br /> l <br /> V i <br /> I: TANK FEE _ ;50.00 each TANK <br /> F I Tanks x t50.00 1906 1961 1900 <br /> A (muitipT'y-1-by lee for 1781 <br /> C each year applicable) <br /> I E $ <br /> L STATE SURCHARGE = 456.00 each TANK (see CA HEALTH It SAFETY CODE'Sec 25201 for applicability) <br /> 1 <br /> T I Tanks x ;56.00 1906 1301 I908 1909 <br /> Y (enter liount and year) <br /> F <br /> ANENT CLOSURE (Removal or Closure-in-place) <br /> URE FEE = 1?0,00 each TANAI Tanks x 134.04ORARY CLOSURE (Only alloyed one time for up tollivo years) <br /> ORARY CLOSURE_FEE _ ;00.00 each TANK- 1 Tanks x 130.00 ; <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> 11 PLAN CHECK FEE = 130.00 each SUBMISSION/RESUCMISS101I S <br /> REPAIR <br /> R TANK REPAIR FEE = 0I0.00 each TANK I Tanks x $110.00 ; <br /> E <br /> P --- <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> ( <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> When applicable} Wien applicable) When applicable) <br /> FEE 130.00/hr FEE = ;3,.04/hr FEE o 135.00/hr ; <br /> TOTAL DUE ; <br /> 4FFICE d51' ONiY <br /> l <br /> SWEEPS 1 COMP I LOC CODE DIST CODE AMOUNT OU£TAMOUNT RCVO CHECK IICASH RCVD DY DATE RECEIVED PERMIT <br />