Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEAL H JiV510N <br />LUNGE ND STORAGE TANK PROGRAM - FEE WORKSHEET A6 <br />Sl <br />FACILITY SITE NAME I FACILITY CCNTA E <br />I <br />T <br />� 1988 � <br />-Ei <br />FACILITY ADDRESS SITE PHONE N with AREA CODE <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = S100.00 <br />& <br />CITY <br />S�ATE� ZIP CODE <br />` <br />I T of TANKS <br />at SITE <br />Al <br />I XXXX XXXX <br />' XXXX ` <br />P <br />P <br />APPLICANT/B LING NrME � /'/ <br />d/ � � <br />APPLICAA T' CONTACT NAME (� <br />II <br />�s 0, U 0 (/ %/T L <br />C �/� V <br />Cl <br />NAILING ADDR'ESSAPPLICANT <br />PHONE WITH AREA CODE <br />FACILITY PENALTY FEES ASSESSED (If Ac plicable) <br />, XXXX ( XXXX <br />` XXXX i <br />N <br />TJ <br />CITY <br />S40 <br />� <br />A E ZTP E _—_-�r'TYPE of APPLICATION <br />�i Closure, Ins:altation, etc.) <br />/ 7 , .,55 <br />TOTAL <br />R! 3EPAIR F__ (Workplan Review & Construction inspections) <br />E <br />P� TANK LINING REPAIR FEE = S78.00/hour (3 hours minim/TANK) <br />A! <br />i) TANK RETROFIT REPAIR FEE = 378.00/hour (3 hours min./FACILITY) <br />R, <br />i PIPING REPAIR FE=- = S78.00/hour (3 hours minimum/FACILITY) <br />M! TRANSFER FEE = S20.00 <br />I! <br />Si <br />C! CONSULTATION FEE = S78.00/hr <br />FnR nFFTCP USE ONLY <br />TANK I.O. +(s) <br />i <br />4 TANK(s) X 5234.00 = S <br />= S234.00 minim 3 <br />= 3234.00 minimum 3 <br />UNAUTHORIZED RELEASEE EVALUATICN = S78.00/hr <br />I SAMPLING INSPECTION FEE = S78.00/hr <br />i5 <br />1 <br />! S <br />TOTAL DUE S <br />EH 23 032 (REVISED 1-12-98) <br />1986 i 1987 <br />� 1988 � <br />1989 C 1990 <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = S100.00 <br />A <br />I XXXX XXXX <br />' XXXX ` <br />XXXX I XXXX <br />S XXXXXXXX <br />C' <br />TI <br />FACILITY PENALTY FEES ASSESSED (If Ac plicable) <br />, XXXX ( XXXX <br />` XXXX i <br />XXXX I XXXX <br />S XXXXXXXX <br />I <br />VI <br />TANK r'=_E = 550.00/TANK (Prior to January 1,1991) � <br />5170/TANK (After <br />January <br />t, 1991) <br />E <br />T Tanks = 1988 ( 1989 11990 1991 1 1992 i <br />1993 1994 i 1995 <br />1996 ! <br />1997 <br />F) <br />(multiply T by fee for <br />Al <br />each year applicable) ' XXXX I XXXX I XXXX XXXX XXXX E <br />I <br />I <br />; <br />C. <br />11 <br />TANK PENALTY FEES ASSESSED ( XXXX XXXX I XXXX XXXX !XXXX i <br />i <br />f I <br />13 <br />L! <br />I! <br />STATE SURCHARGE FOR NEW FACILITIES ONLY=318.30 <br />S <br />T <br />YI <br />T TankS x 38.00 1988 through 1993 (S56) , <br />1993 chrough <br />1997 <br />j <br />5 <br />SURCHARGE FOR 1998 I XXXXXXXXXXXXXXXXXXXXXXXXXXX 1 XXXXXXXXXXXXXXXXXXXXXXX <br />C: PERMANENT CLOSURE (Removal or Authorized Ctosure-in-Place) ! <br />TANK I.O. :(s) <br />L: <br />Oj <br />CLOSURE FE_ = S78.00/hour (3 hours minimum/TANK) <br />TANK(s) X <br />5234.00 <br />= <br />S <br />Si <br />U! <br />TEMPORARY CLOSURE (Plan Review & Inspections) <br />TANK i.0. `(s) <br />R <br />E; <br />TEMPORARY CLOSURE FEE = 378.00/hour (3 hours minim/FACILITY) j <br />5234.00 minimum <br />S <br />Pj ;NSTAL aTICN PLAN CHECK (Plan Review & Construction tnspections)I <br />TANK I.D. +(s) <br />L <br />Al <br />N! <br />PLAN CHECK FEE = $78.00/hour (8 hours minim/FACILITY) <br />= S624.00 minim <br />S <br />R! 3EPAIR F__ (Workplan Review & Construction inspections) <br />E <br />P� TANK LINING REPAIR FEE = S78.00/hour (3 hours minim/TANK) <br />A! <br />i) TANK RETROFIT REPAIR FEE = 378.00/hour (3 hours min./FACILITY) <br />R, <br />i PIPING REPAIR FE=- = S78.00/hour (3 hours minimum/FACILITY) <br />M! TRANSFER FEE = S20.00 <br />I! <br />Si <br />C! CONSULTATION FEE = S78.00/hr <br />FnR nFFTCP USE ONLY <br />TANK I.O. +(s) <br />i <br />4 TANK(s) X 5234.00 = S <br />= S234.00 minim 3 <br />= 3234.00 minimum 3 <br />UNAUTHORIZED RELEASEE EVALUATICN = S78.00/hr <br />I SAMPLING INSPECTION FEE = S78.00/hr <br />i5 <br />1 <br />! S <br />TOTAL DUE S <br />EH 23 032 (REVISED 1-12-98) <br />