Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVISION <br /> 'RGROUND STORAGE TANK PROGRAM - FEE <br /> S FACILITY SITE NAME FACILITY COW, CT NAME <br /> I <br /> T <br /> E FACILITY ADDRESS I SITE PHONE # with AREA CODE <br /> b <br /> CITY STATEI ZIP CODE I of TANKS <br /> A 1 at SITE <br /> P <br /> P APPLICANT/BILLING NAME i APPLICANT CONTACT NAME <br /> L <br /> I <br /> C MAILING ADDRESS I APPLICANT PHONE # WITH AREA CODE <br /> A <br /> N <br /> T CITY I STATEI ZIP CODE ( TYPE of APPLICATION <br /> (Closure, Installation, etc.) <br /> TOTAL <br /> 1986 1 1987 1 1988 f 1989 1 1990 <br /> ANNUAL FACILITY FE=_ (Prior to January 1, 1991) = S100.00 <br /> A I xxxx X)= X( I XX)D( I XXXX S XXXXXXX)O=XX <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) 1 XXXX XXXX xxxx X)OCX x)ooc S XXXXXXXXXXXXX <br /> I <br /> V TANK FEE = S50.00/TANK (Prior to January 1,1991) I S170/TANK (After January 1, 1991) <br /> E <br /> Tanks = 1986 1 1987 11988 1 1989 1WOj 1991 1 1992 1993 11994 11995 1996 <br /> F (multiply $ by fee for 5 <br /> A each year applicable) rxxxx XXXX ( XXXX I XXXX I XXXX 1 <br /> C <br /> I TANK PENALTY FEES ASSESSED 1 XXXX 1 XXXX I XXXX , XXXX XXXX I 1 S <br /> L <br /> I STATE SURCHARGE = S56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> T <br /> Y # Tanks x 556.00 1 1988 through 1990 1991 through 1996 <br /> (Enter amount and year) 5 <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) I TANK I.D. #(s) <br /> 5 <br /> L 1 <br /> 0 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X S234.00 = <br /> S <br /> U TEMPORARY CLOSURE (Plan Review 8 Inspections) TANK I.D. #(s) <br /> R <br /> EI TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/FACILITY) ` S234.00 minimum S <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A S <br /> N PLAN CHECK FEC = 578.00/hour (8 hours minimum/FACILITY) = 5624.00 minimum <br /> R1 REPAIR FEE (Workplan Review 8 Construction Inspections) I TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE = S78.00/hour (3 hours minimum/TANK) ( # TANK(s) X 5234.00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = 5234.00 minimum 5 <br /> R � <br /> PIPING REPAIR FEE = S78.00/hour (3 hours minimum/FACILITY) = SZ34.00 minimum ( S ;Z <br /> M TRANSFER FEE = $20.00 1 UNAUTHORIZED RELEASEE EVALUATION = 578.00/hr I S <br /> I I i <br /> S <br /> C CONSULTATION FEE = S78.00/fir I SAMPLING INSPECTION FEE = 578.00/hr <br /> TOTAL DUE 5 <br /> FOR OFFICE USE ONLY _- <br /> :: ==_=• _ <br /> SWEEPS # I COMPUTER # I LOC CODE I OIST CODE i AMOUNT RECEIVED I CHECK */CASH ( RECEIVED BY I DATE RECEIVED = <br /> IS i <br />