Laserfiche WebLink
SAN JOAQUIN COUNT JBLIC HEALTH SERVICES-ENVIRONM AL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> I Lawrence Livermore National Laborato LLNL C. Susi Jackson <br /> T FACT ITY ADDRESS SITE PHONE#with AREA CODE <br /> E Corral Hollow Road 510 423-6577 <br /> & CITY STATE ZIP CODE #OF TANKS at SITE <br /> A Tr CA 95376 1 for Building 814 <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P LLNL C. Susi Jackson <br /> L MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> I 7000 East Ave., P.O. Box 808 1 (510) 423-6577 <br /> C CITY STATE ZIP CODE TYPE OF APPLICATION(Closure,Installation,etc.) <br /> A <br /> N Livermore CA 94550 Tank closure <br /> T <br /> A ANNUAL FACILITY FEE(Prior to 1986 1987 1988 1989 1990 <br /> C January 1, 1991) = $100.00 <br /> T $ <br /> I <br /> V FA PENALTY FEES ASSESSED xxxx xxxx $ <br /> E if a licable <br /> TANK FEE=$50.00/TANK(Prior to January 1, 1991) 170/TANK <br /> After Janu 1, 1991) <br /> F #Tanks = 1986 1987 1988 1 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply #by fee <br /> for <br /> C each year applicable $ <br /> I <br /> L TANK PENALTY xxx xxx $ <br /> I FEES ASSESSED <br /> -T STATE SURCHARGE=$56 each TANK(Due every 5 years)See California H&S Code,Section 25287 <br /> Y <br /> #Tanks=e x$56.00(enter amount and year) 1986 throu h 1990 1991 throu h 1996 <br /> C PERMANENT CLOSURE(Removal or Authorized Closure-in-Place) TANK I.D.#(s) <br /> L <br /> O CLOSURE FEE-$78.00/hour(3 hours minimum/TANK) TANK I.D. #(s) I x $234.00= $ 234.00 <br /> S <br /> U TEMPORARY CLOSURE(Plan Review&Inspections) TANK I.D. <br /> R I I #(s)---------------------- <br /> E ITEMPORARY CLOSURE FEE=$78.00/hour #TANK(s)_x$234.00= $ <br /> (3 hours minimum/TANK) <br /> P INSTALLATION PLAN CHECK(Plan Review&Construction—7TANK I.D. #(s) <br /> L Inspections) <br /> A PLAN CHECK FEE- $78.00/hour(8 hours minimum/Facility)=$624.00 minimum $ <br /> N <br /> R REPAIR FEE(Workplan Review &Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE=$78.00/hour(3 hours TANK I.D.#(s) x $ <br /> A minimum/I`ANK) $234.00 = <br /> I TANK RETROFIT REPAIR FEE=$78/hour(3 hours minimum/FACILTTY)=$234 minimum $ <br /> R <br /> PIPING REPAIR FEE=$78.00/hour(3 hour minimum/FACILITY)=$234.00 minimum $ <br /> M TRANSFER FEE=$20.00 UNAUTHORIZED RELEASE EVALUATION= $ <br /> I I $78.00/hr <br /> S CONSULTATION FEE=$78.00/hr SAMPLING INSPECTION FEE=$78.00/hr $ <br /> C <br /> OFFICIAL USE ONLY TOTAL DUE $ 234.00 <br /> SWEEPS# COMPUTER# LOC DISTAMOUNT CHECK#/ RECEIVED DATE RECEIVED <br /> CODE CODE RCVD CASH BY <br /> a•:;,ativxxaxa;;;;aoa•;ecx;•xa•:aa:;;;,;a•:>:,.:;•::::�:.:�:y;;to:.:s:;<•:::::;«.::;;;::.::.» ;;.:::.::::.::::::::::::::•::>:.:::::;•::;:::::•::•:::•::::•;:•:�::.::•:;•:::•::.::;.s:.:::<::.>:::.:,;;.::.:::•:::•>:;.:�:;.;•:::.. <br /> 11 <br />