Laserfiche WebLink
S <br />I <br />T <br />"E <br />8 <br />A <br />P <br />P <br />L <br />I <br />C <br />A <br />N <br />T <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVSION <br />UNDERSMAD STORAGE TANK PROGRAM - FEE WORKSHEET <br />FACILITY SITE NAMEfe <br />16 /4/7r <br />FACILITY 0 A A E A./ <br />V I' <br />1986 <br />FACILITY ADDRESS ��It-ow <br />SI PHO with AREA CODE <br />/Wei <br />Z ( <br />Fly_ <br />CITY�0� <br />ST TEJ <br />ZIP CODE <br />o TANKS <br />S S !j <br />XXXX <br />Aip <br />at SITE <br />APPL T/8[ LNG NAM <br />APPL NT CON ACT NAM <br />a VlG <br />' <br />/ <br />MAIL NG A RESS <br />APPLI NT PHONE # WITH AREA�C E <br />CITY <br />STATE <br />ZIP CODE <br />TYPE of APPLICATION `5 <br />(Closure, Installation, etc.) <br />I TOTAL <br />RE AIR FEE (Workp(an Review & Construction Inspections) <br />TANK I.D. #(s) <br />1986 <br />1987 <br />1988 11989 <br />1990 <br />A <br />I <br />R <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br />S <br />PIPING REPAIR FEE = S78.00/hour (3 hours minimum/FACILITY) = 5234.00 minimum <br />S S !j <br />XXXX <br />XXXX <br />XXXX � XXXX <br />XXXX 5 XXXXXXXX <br />A <br />C <br />T <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />XXXX <br />XXXX <br />` <br />XXXX XXXX <br />XXXX S XXXXXXXX <br />I <br />I <br />V <br />TANK FEE = 550.00/TANK (Prior to January 1,1991) <br />5170/TANK (After January 1, 1991) <br />E <br /># Tanks = <br />1988 <br />1989 <br />1990 <br />1991 <br />1992 <br />1993 <br />1994 <br />1995 <br />1996 1997 <br />1998 <br />F <br />(multiply # by fee for <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />I <br />S <br />A <br />each year applicable) <br />C <br />I <br />TANK PENALTY FEES ASSESSED <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />S <br />L <br />I <br />STATE SURCHARGE FOR NEW FACILITIES ONLY=518.50 S <br />T <br />Y <br /># Tanks x 58.00 <br />1988 through 1993 (S56) <br />1993 through 1997 (S56) <br />1998 <br />SURCHARGE FOR 1998 <br />XXXXXXXXXXXXXXXXXXXXXXXXXXX <br />XXXXXXXXXXXXXXXXXXXXXXX <br />S <br />C� PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) TANK I.D. #(s) <br />L <br />0 <br />CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = S <br />S <br />U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) <br />R <br />EI TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/FACILITY) 5234.00 minimum S <br />P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br />L <br />A <br />N PLAN CHECK FEE = S78.00/hour (8 hours minimum/FACILITY) = $624.00 minimum S <br />MI TRANSFER FEE = $20.00 <br />I. <br />CONSULTATION FEE = S78.00/hr <br />FOR OFFICE USE ONLY <br />UNAUTHORIZED RELEASE EVALUATION = S78.00/hr <br />SAMPLING INSPECTION FEE = S78.00/hr <br />S <br />fSS TOTAL DUE <br />:H 23 032 (REVISED 1-12-98) <br />RE AIR FEE (Workp(an Review & Construction Inspections) <br />TANK I.D. #(s) <br />P <br />T NK LINING REPAIR FEE = S78.00/hour (3 hours minimum/TANK) <br /># TANK(s) X 5234.00 = <br />S <br />A <br />I <br />R <br />ANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = S234.00 minimum <br />S <br />PIPING REPAIR FEE = S78.00/hour (3 hours minimum/FACILITY) = 5234.00 minimum <br />S S !j <br />MI TRANSFER FEE = $20.00 <br />I. <br />CONSULTATION FEE = S78.00/hr <br />FOR OFFICE USE ONLY <br />UNAUTHORIZED RELEASE EVALUATION = S78.00/hr <br />SAMPLING INSPECTION FEE = S78.00/hr <br />S <br />fSS TOTAL DUE <br />:H 23 032 (REVISED 1-12-98) <br />