COMPLIANCE INFO_1986-2001 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUe1'Y PUBLIC HEALTH SERVICES - ENVIRONMENTALN H DIVSION ROUND STORAGE TANK PROGRAM - FEE WORKSHE S FACILITY SITE NAME FACILITY CONTACT NAME I T •E FACILITY ADDRESS SITE PHONE # with AREA CODE & t o 3o S O j i ✓E AVE 2,0'7 - 114-8 -(, '13 CITY STATE ZIP CODE # of TANKS A SToC�Z� �S-7 at SITE Z P P PLICANT ILLING NAME APPLICANT CONTACT NAME L G L�r� Cs!�/E�" nl /PVL I C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE " N 0 box IoZS X11 -3�3 - i(68 T) CITYw• StctC2Rl'►'lrCcSTATE ZIP CODE TYPE of APPLICATION �/IJSTA(CATIC orJ (Closure, Installation, etc.) TOTAL 1986 1987 1988 1989 1990 ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 A XXXX XXXX XXXX XXXX XXXX S XXXXXXXX � C T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XXXX XXXX XXXX XXXX $ XXXXXXXX I V TANK FEE _ $50.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) E # Tanks = 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 I F (multiply # by fee for A each year applicable) XXXX XXXX XXXX XXXX XXXX 7e $ 34o- f C I TANK PENALTY FEES ASSESSED XXXX XXXX XXXX XXXX XXXX $ L I STATE SURCHARGE FOR NEW FACILITIES ONLY=518.50 $ T Y # Tanks Z x $8.00 1988 through 1993 (S56) 1993 through 1997 ($56) 1998 SURCHARGE FOR 1998 XXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXX $ I ' C PERMANENT CLOSURE (Removal or Authorized Closure-in-PLace) TANK I.D. #(s) L 0 CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) # TANK(s) X 5234.00 = $ S i U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) i R ( El TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/FACILITY) $234.00 minimum $ t f P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) -7(0—( L N PLAN CHECK FEE = S78.00/hour (8 hours minimum/FACILITY) = $624.00 minimum S �p2�,c310 R REPAIR FEE (Workplan Review & Construction Inspections) TANK I.D. #(s) E P TANK LINING REPAIR FEE = $78.00/hour (3 hours minimum/TANK) # TANK(s) X 5234.00 = $ A I TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = S234.00 minimum S R i PIPING REPAIR FEE = $78.00/hour (3 hours minimum/FACILITY) _ $234.00 minimum S M TRANSFER FEE = S20.00 UNAUTHORIZED RELEASE EVALUATION = $78.00/hr $ � I S C CONSULTATION FEE _ $78.00/hr SAMPLING INSPECTION FEE = S78.00/hr $ TOTAL DUE S $O,�- ,FOR OFFICE USE ONLY ....«........ ................»»..«.«»............»» ........._._.............-..««.............. ............._......«....._..««...««.«....... .................... _..._.«».. .. .._..._.y._..._.«..«.».^.•r..-««-::::.-...........—^a:: ._..«...._............. ........ ...........».......................•r..........«_..»_._. ....n...................sr:.ss:..........__....»..»......ii.: ..._...»......_....... ..«..........._.........._....�«._.............».._............«._.. ...._....«.....c.: _^•»:................................»...._»....».. «»._.................................. ...»..........»_.. :::-:::::.•e::««:::::::::«:«:•_ - �....s SWEEPS # COMPUTER # LOC CODE DIST CODE AMOUNT RECEIVED CHECK #/CASH RECEIVED BY DATE RECEIVED _ «.._.......... .. .......................»........i...........«.........._...__.....................................»»...................._-it...««....«........................................... ......»........-.....«.« .5::.:::L::i:: ..««.............»».................«..:..»..«.......... . .....»............................... ........................««......._. ......«...«.......«.._.«.................».......»_.......»....._..............._.«_...... :«:s«::�• :::::«:::::::::::::«::«i::::::::::«r.:.....;..:::a:::::::::««:::c::c::c:a.«:::::ti.«::::«:::«�««::::«::::::«:::x::r.:::::x«�:::«.^-.•c::m:::«.u«..«........«...........».........._»c.......u.«..«__.._.a»»......._....:.._....».._...._z_»..»_...»»..«.....«..._......:.........»..� EH 23 032 (REVISED 1-12-98) 0