Laserfiche WebLink
N TRANSFER FEE a !20.00 UNAUTHORIZED RELEASE EVALUATION = S78.00/hr <br />S <br />C CONSULTATION FEE = $78.00/hr SAMPLING INSPECTION FEE = 578.00/hr <br />c,2 OFFICE USE ONLY <br />SWEEPS ! COMPUTER N LOC CODE DIST CODE AMOUNT RECEIVED CHECK N/CASH <br />IS - <br />ANNUAL � <br />EM 23 032 (REVISED 1.12-98) <br />II5 <br />TOTAL OUE S <br />i!°�ii?Vli qJpt oe;� ji� 4 u�� � <br />RECEIVED BY DATE RECEIVED <br />FACILITY FEE (Prior to January 1, 1991) = $100.00 <br />1986 1987 <br />1988 <br />1989 <br />1990 <br />SAN JONIUIN COUNTY PUBLIC HEALTH SERVICES <br />- ENVIRONMENTAL HEALTH OIVSION <br />XXXX xxxx <br />UNDERIWOUND STORAGE TANK P - FEE UORKSHEET <br />XXXX <br />FACILITY SITE NAME <br />S xxxxxxxx <br />I <br />FACILITY CONTACT NAME <br />xxxx xxxx <br />-- <br />xxxx, <br />xxxx <br />E <br />I <br />.-- i t l t TY ADDRESS <br />�c <br />INSTALLATION PLAN CHECK (11186 Review b Construction Inspections) <br />SITE PHONE R with AREA CODE <br />t <br />S xxxxxxxx <br />V <br />TANK FEE = 550.00/YANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br />E <br />A <br />P <br />CITY <br />l Pin <br />STATE <br />ZIP CODE <br />N of TANKS <br />et SITE <br />1989 <br />0 <br />D BILLING NAME <br />1993 <br />APPLICANT CONTACT NAME <br />1995 <br />1996 <br />1997 <br />1998 <br />+! tANK(s) $234.00 <br />A <br />each year sppliesble) <br />C <br />FLING ADDRESS <br />xxxx <br />xxxx xxxx <br />APPLICANT PlHO/NE # WITH AREA CODE <br />N <br />PIPING REPAIR FEE 9 378.00/hour (3 hours mfnimun/FACILITY) <br />s 5234.00 minimum <br />�r <br />C <br />1 <br />CITY <br />STATE <br />. <br />YIP CODE <br />-2 <br />TYPE of APPL <br />(Ctosur Instatlati etc.) <br />N TRANSFER FEE a !20.00 UNAUTHORIZED RELEASE EVALUATION = S78.00/hr <br />S <br />C CONSULTATION FEE = $78.00/hr SAMPLING INSPECTION FEE = 578.00/hr <br />c,2 OFFICE USE ONLY <br />SWEEPS ! COMPUTER N LOC CODE DIST CODE AMOUNT RECEIVED CHECK N/CASH <br />IS - <br />ANNUAL � <br />EM 23 032 (REVISED 1.12-98) <br />II5 <br />TOTAL OUE S <br />i!°�ii?Vli qJpt oe;� ji� 4 u�� � <br />RECEIVED BY DATE RECEIVED <br />FACILITY FEE (Prior to January 1, 1991) = $100.00 <br />1986 1987 <br />1988 <br />1989 <br />1990 <br />L <br />A <br />C <br />XXXX xxxx <br />XXXX <br />XXXX <br />XXXX <br />S xxxxxxxx <br />I <br />FACILITY PENALTY FEES ASSESSED (If Applieeble) <br />xxxx xxxx <br />xxxx <br />xxxx, <br />xxxx <br />E <br />I <br />$234.00 minimum <br />INSTALLATION PLAN CHECK (11186 Review b Construction Inspections) <br />TANK 1.0. A(s) <br />I <br />l <br />S xxxxxxxx <br />V <br />TANK FEE = 550.00/YANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br />E <br />N <br />PLAN CHECK fEE • 178.00 /hour (8 hours minimum/FACILtTY) <br />F <br />/ Tanks = <br />(multiply k by fee for <br />1988 <br />1989 <br />1990 <br />1 1941 1992 <br />1993 <br />1994 <br />1995 <br />1996 <br />1997 <br />1998 <br />+! tANK(s) $234.00 <br />A <br />each year sppliesble) <br />kxxx <br />xxxx <br />xxxx <br />xxxx xxxx <br />R <br />PIPING REPAIR FEE 9 378.00/hour (3 hours mfnimun/FACILITY) <br />s 5234.00 minimum <br />C <br />$ <br />i <br />TANK PENALTY FEES ASSESSEO <br />XXXX <br />xxxx <br />xxxx <br />xxxx xxxx <br />L <br />S <br />t <br />STATE SURCHARGE FOR NEW FACILITIES ONLY=519.50 <br />T <br />S <br />I tanks x 58.00 <br />1988 through 1993 ($56) <br />1993 t=7XXXXS16) <br />1998SURCHARGE <br />FOR 1998 <br />XXXXXXXXXXXXXXXXXXXXXXXXXXX <br />XXXXXXXX1 <br />S <br />N TRANSFER FEE a !20.00 UNAUTHORIZED RELEASE EVALUATION = S78.00/hr <br />S <br />C CONSULTATION FEE = $78.00/hr SAMPLING INSPECTION FEE = 578.00/hr <br />c,2 OFFICE USE ONLY <br />SWEEPS ! COMPUTER N LOC CODE DIST CODE AMOUNT RECEIVED CHECK N/CASH <br />IS - <br />ANNUAL � <br />EM 23 032 (REVISED 1.12-98) <br />II5 <br />TOTAL OUE S <br />i!°�ii?Vli qJpt oe;� ji� 4 u�� � <br />RECEIVED BY DATE RECEIVED <br />C PERMANENT CLOSURE (Removal or Authorized Closure -in -Piece) <br />I TANK I.D. X(s) <br />L <br />0 CLOSURE FEE s 578.00/hour (3 hours minimLm/TANK) <br />N TANK(s) X S234.00 <br />= <br />U <br />P A11Y Cl It (pith Rwiew t Inspections) <br />TANK I.O. S(s) <br />R <br />E <br />TE ARY CLOSURE FEE • !71!.00/hair (3 hags minimam/FACILITY) <br />$234.00 minimum <br />INSTALLATION PLAN CHECK (11186 Review b Construction Inspections) <br />TANK 1.0. A(s) <br />I <br />l <br />A <br />N <br />PLAN CHECK fEE • 178.00 /hour (8 hours minimum/FACILtTY) <br />$624.00 minimum <br />R <br />REPAIR FEE (Norkpien Review 6 Construction Inspections) <br />TANK I.D. R(s) <br />E <br />P <br />TANK LINING REPAIR FEE • 578.00/hour (3 hours minimus/TANKS <br />+! tANK(s) $234.00 <br />A <br />X = <br />I <br />TANK RETROFIT REPAIR FEE a $78.00/hour (3 hours min./FACILITY) <br />= S234.00 minimum <br />R <br />PIPING REPAIR FEE 9 378.00/hour (3 hours mfnimun/FACILITY) <br />s 5234.00 minimum <br />N TRANSFER FEE a !20.00 UNAUTHORIZED RELEASE EVALUATION = S78.00/hr <br />S <br />C CONSULTATION FEE = $78.00/hr SAMPLING INSPECTION FEE = 578.00/hr <br />c,2 OFFICE USE ONLY <br />SWEEPS ! COMPUTER N LOC CODE DIST CODE AMOUNT RECEIVED CHECK N/CASH <br />IS - <br />ANNUAL � <br />EM 23 032 (REVISED 1.12-98) <br />II5 <br />TOTAL OUE S <br />i!°�ii?Vli qJpt oe;� ji� 4 u�� � <br />RECEIVED BY DATE RECEIVED <br />