Laserfiche WebLink
A JOAQUIN LOCAL HEALTH 9ISTRICT <br />UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br />IF FAC1LItY/SITE�NAME FACILITY CONTACT NAME - <br />C Ske l(1 <br />�' i'y Ce S4for,� <br />L STREET ADDRESS SIT _... JM rN rA1ICA cool <br />T W Vtch E PHONE t 3 <br />:�4z_-SGS' <br />Y CITYL00l fSTI�TE LIP CODE 1 of Tanks <br />_ -71- at Site <br />F APPLICANT/BILLING NAME •'-�� - --- <br />APPLICANT CONTACT NAME <br />P G <br />L °beef'_ Lc�� o� fls_�a�ic�-SCS <br />I MAILING ADDRESS APPLICANT PHONE i MIrN AREA coot <br />N city <br />AT IIP 'CODE p <br />C`Q'/'1'JPrtp r ••y c�osu�c �NPIib etch iv, <br />FACILITY FEE - 1100,00 each SITE ADDRESS per YEAR <br />._.._._._..._._._ <br />TOTAL <br />1986... <br />T 1987 1988 1589 — <br />E TANK FEE = 150.00 each TANK <br />F '17T anks x 150.00 198] 1980 <br />A (auitipro_ by fee for _ 1989 <br />C each year applicable) ��' - <br />L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH I SAFETY CODE Sec 2528.7 -for a applicability) <br />T I lanks„��_ x 156.00 1986 198] <br />Tenter _ — ~_-- <br />enter anouoand year) 1508 1983 <br />-_Et_1 _ <br />I CC <br />C PERMANENT CLOSURE (Removal or Closure -in-place) <br />L _ _ <br />0 CLOSURE FEE = 190.00 each TANK <br />--------------- <br />(SI - -- 1 Tanks _ x <br />P. TEMPORARY CLOSURE (Only allowed one tine for up to tvo years) —. <br />E..._....._. _ _ <br />TEMPORARY CLOSURE FEE = 180.00 each TANK M~! -`•`"- --••---- <br />_.-._._------,.,Tanks+ _ x 190.00 1 <br />P PLAN <br />A <br />11 PLAN CHECK FEE = 130.00 each SUBMISSION/RESUCMISSIOH y <br />30 <br />..REPAIR ..,_ ....._._,...—--.�.._.._-_.._........_.__.._ ____ ---•--___._ <br />R TANK. REPAIR FEE - 1110.00 each TANK <br />E -• •._.._._..-._.._.. ___,� ._._,_,, _ _-, 1 Tanks <br />...... x 1110.00 <br />P <br />A PIPING hour, <br />REPAIR/CLOSURE/REMOVAL (Fees are per '-��-"` -• - <br />_ , minimua one hour to be paid on plan submittal) _ <br />R UNAUTHORIIED RELEASE EVALUATION - CONSTRUCTION INSPECTION SAMPLING IIISPECTION� -r!�----�-' <br />(when applicable) _ (when applicable) <br />_ _ (when applicable) <br />FEE = 130.:.00/hr�- ----- _._ e..-- ._......-,... _____.... __. _. _ .._ __ ...._ <br />FEE 19,.00/hr( FEE - 135.00/h�N_„___. <br />OFFICE USE ONLY TOTAL DUE - <br />.ww,wp��;oWuuwuu.Y:4iEYYYL':IUYlYfIG�gn�uu,uGuhWhiIJIIIII�I.uIJUI11.ut�:�,N <br />DEEPS 1L)tIlmlmllm <br />COMP 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT Rr,VD CHECK 1/CASH Rr,VD DY DATE RECEIVED PERMIT 1 <br />� n� averde ..........�. ,. _ /c1 r��/� 5 ._ <br />