Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIROIRH_ATAL HEALTH DIVSION <br /> UND OUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> IRW S FACILITY SITE NAME �{. FACILITY CONTA i NAME <br /> T S ufhland -eleven 20to32 <br /> E FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> 4027 Da Virtu �'we. <br /> CITY 77TSTATE ZIP CODE # of TANKS <br /> A 5toGk-ton CA Gt r-�-� at SITE (newt <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L R L n6 Zain &iviiino <br /> I <br /> C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> Ar &5d Howl, Avenue, , 05o4- (tet�to� cooly-4003 <br /> N <br /> T STATE UP CODE TYPE of APPLICATION <br /> 5a6rarnertto Cly (Closure, installation, etc.) (nsi'allafirn <br /> TOTAL <br /> 1986 ( 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) _ $100.00 <br /> A XXXX E XXXX XXXX XXXX XXXX 5 XXXXXXXX <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX ( XXXX I XXXX I XXXX XXXX S XXXXXXXX <br /> I <br /> V TANK FEE _ $50.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> # Tanks = a ' 1987 11988 1989 1990 1991 1992 1993 11994 1995 1996 1997 <br /> F (multiply # by fee for <br /> A each year applicable) XXXX I XXXX I XXXX I XXXX (XXXX I S <br /> C <br /> I TANK PENALTY FEES ASSESSED I XXXX XXXX XXXX I XXXX XXXX ( I 5 <br /> L <br /> I STATE SURCHARGE FOR NEW FACILITIES ONLY = S18.50 I3 <br /> T <br /> Y # Tanks x $8.00 1988 through 1990 (S56) 1991 through 1996 ($56); 1997 <br /> SURCHARGE FOR 1997 XXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXX S <br /> 00 <br /> C PERMANENT CLOSURE (Removal 'or Authorized Closure-in-Place) I TANK I.D. #(s) <br /> L <br /> 0 CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) I # TANK(s) X $234.00 = S <br /> S <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) I TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/FACILITY) 5234.00 minimum S <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) ; <br /> L <br /> A ��� � <br /> N PLAN CHECK FEE = 578.00/hour (8 hours minimum/FACILITY) = $624.00 minimum Is <br /> R REPAIR FEE (Workplan Review & Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE = S78.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = $234.00 minimum S <br /> R <br /> PIPING REPAIR FEE = S78.00/hour (3 hours minimum/FACILITY) = $234.00 minimum S <br /> M TRANSFER FEE _ $20.00 UNAUTHORIZED RELEASE EVALUATION = S78.00/hr S <br /> I I I <br /> S <br /> C� CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE = 578.00/hr S <br /> TOTAL DUE $ <br /> NJ <br /> FOR OFFICE USE ONLY <br /> SWEEPS # COMPUTER # I LOC CODE DIST CODE-- AMOUNT RECEIVED I CHECK #/CASH RECEIVED BYIDATE RECEIVED <br /> --- - <br /> EH 23 032 (REVISED 5-27-97) <br />