COMPLIANCE INFO_1985-2003 - Laserfiche WebLink

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T SAefOAQUIN LOCAL HEALTH OTRICT UNDERGROUND STORAGE TANK PROGRAM - FEE VORKSHEET S FACILITY/SITE NAME FACILITY FEE = $100.00 each SITE ADDRESS per YEAR TOTAL FACILITY CONTACT NAME P f t L STREET ADDRESS U SITE PH NE t wt." AREA CODE I TANK FEE _ $50.00 each TANK F A _...... ........ w __.....__._._.......... _ # Tanks x $50.00 1986 1987 1988 (multiply-�-by fee for 1989 __. TEMPORARY CLOSURE FEE a_ $80.00 each TANK t Tanks -- x $80.00 Y CITY STATE ZIP CODE of Tanks f at Site ...... _ A APPLICANT/BILLING NAME T Y APPLICANT CONTACT NAME P 1987 -- 1988 --------- 1989 --• ----- I MAILING ADDRESS APPLICANT PHONE 1 NIT" AREA CODE f A N CITY STATE ZIP'CODE TYPE of APPLICATION T�^ i CLOSURE. INSTALLATION, ETC. C FACILITY FEE = $100.00 each SITE ADDRESS per YEAR TOTAL A T ........ ... __._..__...._....__._...____.._____.__.._.._....____ 1986 1987 1988 1989 f t $ U E TANK FEE _ $50.00 each TANK F A _...... ........ w __.....__._._.......... _ # Tanks x $50.00 1986 1987 1988 (multiply-�-by fee for 1989 __. TEMPORARY CLOSURE FEE a_ $80.00 each TANK t Tanks -- x $80.00 C I each year applicable) — f L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH & SAFETY CODE Sec 25287 for applicability) T Y 1 Tanks x 156.00 (enter mount and year) w 1986 — ---- 1987 -- 1988 --------- 1989 --• ----- f C PERMANENT CLOSURE (Removal or Closure -in-place) 0 CLOSURE FEE = $90.00 each TANK � �I Tanks - _ -x $90.00 f S U P, TEMPORARY CLOSURE (Only allowed one time for up to two years) E - TEMPORARY CLOSURE FEE a_ $80.00 each TANK t Tanks -- x $80.00 P L PIAN CHECK _I nstallation or Repair) 00 M PLAN CHECK FEE - $30.00 each SUB ISSIONAESUDMISSION f REPAIR_____.._._. �____.___.._ _....___......._._.__._.........._._......_.. R TANK REPAIR FEE : $110.00 each TANK t Tanks x $110.00 E_.__.______._..._....._____..___. __ ..__ _ ._...._ ______.....__....__.......__........_......_____....._..._..--._.___.___..._...._....__ __._ _ P......._.__ ..__._..__..._ _............_____. A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION (when applicable) (when applicable) (when applicable) ........... FEE FEE = $30.44/hr l FEE _ $35.44/hr�^-..�..._...._ FEE = f35.00/hr�_,� OFFICE USE ONLY i SWEEPS) .COMP .IM., LOC .CODE .DIST CC // a 3,13 TOTAL DUE a AMOUNT DUES I AMOUR RCVD Ii CH � CASH I RCVD BY I DATE RECEIVED1 PERMIT I 777, 7Fq_