COMPLIANCE INFO_2002-2005 - Laserfiche WebLink

Home Browse Search

TRANSFER FEE _ $ 20 CONSULTATION FEE _ $ 89/ HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 89 / HOUR $ SAMPLING INSPECTION FEE _ $ 89/ HOUR $ ALL FEES ARE BASED ON THE $89 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL 1:$tBILLED TO APPLICANT_ OFFICE USE ONLY SERVICE REQUEST # FACILITY tD AMOUNT REC I CHECK 0 RECEIVED BY DATEF R EH 23 032 (REVISED 8-1-01) Y.� SAN JOAQU4'4T[Y PUBLIC HEALTH SERVICES-ENVIRONUNDERD STORAGE TANK PROGRAM HEALTH DIVISION WORKSHEET FACT NAME _` FACILITY COidTACT NAME FACT DR SS C SITE PHO E # WITH AREA CODE C _ 7 STATE "r- / ZIP CODE # OF TANKS AT SITE CA APPLICANT BILLING NAME 1 APPLICANT CONTACT NAME APPLI T MAILING ADDRES APPLICANT PHONE # WITH AREA CODE Cl IiJLL �,: 3 TATE 41P CODE CIRCLIf WORK TO BE DONE: �a� C/ Closure Installation Repair Retrofit ACTIVE FACILITY $500 FEE INCLUDES FACILITY FEE + i TANK 1996 — 9 2000 2001 iAfVK AFTER FIRST TANKks fs37o) x;x tanrs x a of as FTIANK PENIAL—ii ASSESSED TANK SURCHARGE = $8 / TANK $ STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM $ = $10 / FACILITY PERMANENT CLOSURE Removal or Permitted Closure in Place [TANK ID A s) : TEMPORARY CLOSURE CLOSURE FEE _ $267 / TANK $ # TANKS X 5267 = (Plan Review and Inspections) TANK ID ; (s) : TEMPORARY $ CLOSURE FEE _ $267 /FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Ins ections TANK ID # (s) : $ PLAN CHECK FEE _ $712 / FACILITY REPAIR PLAN CHECK TANK 1D # (s) _ TANK LIMPING REPAIR FEE = $267-/ TANK $ # TANKS X$267 - $267=TANK TANK RETROFIT REPAIR FEE = $267 / FACILITY PIPING REPAIR FEE = $267 / FACILITY $ TRANSFER FEE _ $ 20 CONSULTATION FEE _ $ 89/ HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE = $ 89 / HOUR $ SAMPLING INSPECTION FEE _ $ 89/ HOUR $ ALL FEES ARE BASED ON THE $89 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL 1:$tBILLED TO APPLICANT_ OFFICE USE ONLY SERVICE REQUEST # FACILITY tD AMOUNT REC I CHECK 0 RECEIVED BY DATEF R EH 23 032 (REVISED 8-1-01)