COMPLIANCE INFO_1986-2002 - Laserfiche WebLink

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APPLICANT PHONE 9 WITH AREA CODE 49y_ STATE ZIP CODE / TYPE of APPLICATION ^ (Closure, Installation, etc.) TOTAL ANNUAL FACILITY FEE (Prior SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH 0 VSION # TANK(s) X S234.00 = 1986 1 UNDERMIM STORAGE TANK PROGRAM - FEE WORKSHEET 1989 FACILITY SITE NAME Es XXXX ( FACILITY CONTACT NAME T I t S A C N I T I FACILITY PENALTY FEES ASSESSED (If Applicable) C E FACILITY ADDRESS I SITE PHONE I with AREA CODE S V E ., (Prior to January 1,1991) R (After January 1, 1991) F 0 Tanks = (multiply x by fee for t986 1987 1988 11989 11990 STATE ZIP CODE# of TANKS A XXXX XXXX at SITE P 5 A C each year applicable) I L TANK PENALTY FEES ASSESSED I XXXX P APPLICANT/BILLING NAME APPL N CONTASLJAME I S Y STATE SURCHARGE = $56.00 each TANK (Due every -a years) APPLICANT PHONE 9 WITH AREA CODE 49y_ STATE ZIP CODE / TYPE of APPLICATION ^ (Closure, Installation, etc.) TOTAL PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) ANNUAL FACILITY FEE (Prior to January 1, 1991) S100.00 # TANK(s) X S234.00 = 1986 1 1987 1 1988 1989 1990 1 Es XXXX XXXX I R TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = S234.00 minimum S S A C N I T I FACILITY PENALTY FEES ASSESSED (If Applicable) C XXXX I XXXX I S V E TANK FEE = 550.00/YANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) F 0 Tanks = (multiply x by fee for t986 1987 1988 11989 11990 1991 11992 1993 1994 11995 11996 XXXX XXXX 5 A C each year applicable) I L TANK PENALTY FEES ASSESSED I XXXX XXXX I S I T STATE SURCHARGE = $56.00 each TANK (Due every -a years) See California H & S Code, Section 25287 Y # Tanks x 556.00 (Enter amount and year) 1988 through 1990 1991 through 1996 S PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) I TANK I.D. I(s) CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) # TANK(s) X S234.00 = 5 TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) TEMPORARY -CLOSURE FEE = S78.00/hour (3 hours minimum/FACILITY) 5234.00 minimum Es P L INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK P.D. 96) A N PLAN CHECK FEE = S78.00/hour (8 hours minimum/FACILITY) = S624.00 minimum S R REPAIR FEE (Workptan Review & Construction Inspections) TANK I.D. As) P Al TANK LINING REPAIR FEE = S78.00/hour (3 hours minimum/TANK) I 9 TANK(s) X 5234.00 = S I R TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = S234.00 minimum S PIPING REPAIR FEE = S78.00/hour (3 hours minimum/FACILITY) = $234.00 minimum S 1- N I TRANSFER FEE = S20.00 I UNAUTHORIZED RELEASE EVALUATION = S78.00/hr I I S S C CONSULTATION FEE = S78.00/hr I SAMPLING INSPECTION FEE = $78.00/hr S TOTAL DUE I S '7 e F CE USE ONLY _..... ...................._......._ __.._._._...._..._......_..__._........___.._ _. , EEPS # I COMPUTER $ ( LOC CODE I DIST CODE I AMOUNT RECEIVED CHECK I/CASH ` RECEIVED 3Y I DATE RECEIVED I S Ca Y EH 23 032 (REVISED 10-28-93) 3 e r