Laserfiche WebLink
0 6 <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION <br />UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br />FACILITY NAME FACIL,ITY CONTACT NAME <br />` <br />FACILITY( ADDRESS SITE PHONE # WITH AREA CODE <br />v 2 c & (—,7 <br />CITY <br />STATE ZIP CODEC <br /># OF TANKS AT SITE <br />j <br />(� <br />CA <br />ACTIVE FACILITY <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />�y/�y//��\ � <br />Y • 1 • ® I <br />�/ <br />-) Y - <br />2001 <br />APPLICA??NT MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />PIPING REPAIR FEE = $2671 FACILITY <br />UNAUTHORIZED RELEASE EVALUATION FEE _ $ 89 /HOUR SAN <br />$125 PER TANK AFTER FIRST TANK <br />CITY STATE <br />ZIP CODE <br />CIRCLE WORK TO BE DONE: <br />Closure Ifation epair Retrofit <br />Lr� o C C_ <br />��`�� �� <br />ACTIVE FACILITY <br />-2003 <br />CLOSURE FEE = $267 / TANK <br />1996-1999 <br />2000 <br />2001 <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK <br />($170) X (# tanks) x (n or years applicable) <br />PIPING REPAIR FEE = $2671 FACILITY <br />UNAUTHORIZED RELEASE EVALUATION FEE _ $ 89 /HOUR SAN <br />$125 PER TANK AFTER FIRST TANK <br />FNVIROW <br />SAMPLING INSPECTION FEE _ $ 89/ HOUR <br />$ t , <br />TANK PENALTY ASSESSED <br />TANK SURCHARGE= / TANK /® <br />$ �� <br />/ /FACILITY <br />$ %' <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM = <br />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # (s): <br />CLOSURE FEE = $267 / TANK <br />I # TANKS X $267 <br />TEMPORARY CLOSURE <br />Pian Review and Ins tions <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = $267 / FACILITY <br />REPAIR PLAN CHECK <br />TANK ID # (s): <br />TANK LINING REPAIR FEE = $267 / TANK <br /># TANKS X $267 <br />$ <br />TANK RETROFIT REPAIR FEE = $267 / FACILITY <br />$ <br />PIPING REPAIR FEE = $2671 FACILITY <br />MISCELLANEOUS <br />TRANSFER FEE _ $ 20 <br />CONSULTATION FEE _ $ 89/ HOUR <br />UNAUTHORIZED RELEASE EVALUATION FEE _ $ 89 /HOUR SAN <br />c�ulrl �� <br />E >L1F{ SER`i}OE <br />FNVIROW <br />SAMPLING INSPECTION FEE _ $ 89/ HOUR <br />ALL FEES ARE BASED ON THE $89 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED IU APPLIGAN I. <br />TSI.-7.SM 1 30`f I —Z -1L I �(� (oa- <br />23 <br />