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v i S h I% <br />C PERMANENT CLOSURE (Reaoval or A <br />L Uthor(Zed Closure -fn -Place) TANK T.D. /(q <br />D CLOSURE FEE + !78,00/hour (3 hours etiniauoMK)/TA <br />S IF TANK(a)_ % f2U,00 . S <br />U TE)PCRART CLOSURE (Pian Reviewd [ropectiam) <br />R TANK I.D. f(a) <br />E TEMPORARY CLOSURE FEE a 178.00/hour (3 hard ainimua/FACILITT) ,)0 minfsaa <br />S <br />P INSTALLATION PLAN CHECK (Plan RevieN A C"truetion Inspections) TANK I.O. t(a) <br />L <br />A <br />N PLAN CRECK FEE • S78,00/how IS hours miniehmyFACILITY) <br />1624.00 ■tntshua f <br />R REPAIR fEE (Uorkplan Review i Cantruetion Irrpeotioru) TANK I.D. 1(s) <br />E <br />P TANK LlN1MG REPAIR FEE + 278-00/hour (3 hours alninn/TARK) R TANK(a) K x.00 , <br />A f <br />I tANX RETROFIT REPAIR FEE • f78.00/how (3 hours •In./FACILITT) • 3234-DO <br />mi <br />R S <br />PIPING REPAIR FEE • 2781-00/hour (3 hours ofnfa WFACILITY) • f23A.00 Minlaaw <br />5 <br />N TRANSFER FEE •520,00 UNAUTNORIZEO RELEASE EVALUATION • f78.00/hr <br />1 <br />S <br />C CONSULTATION FEE • f7S.00/hr SAMPLING INSPECTION FEE • f78.00/hr <br />TOTAL DUE <br />FOR OFFICE USE OMIT __ /" <br />i1 jh�•��si.•iT+i�••—ir�rss`�Cs Ci=.►������G�wii���� <br />T Ufsr� �y%Jt1Mi �1�lets�et�ts <br />a aCGt1 VED dT <br />-- SIS <br />�� �_ f <br />s••a•ss rs saieww'a'sehs�issia�rsa�ww.ianrii�iti�.ii.sia�i, <br />EN 23 032 fREYfSEO 3-1-951 Paas it <br />'> J <br />1_Y` , <br />S <br />f <br />f <br />LL <br />p72�1 <br />1 <br />SAN JOAWIN CCtJN A <br />CH TN SERVICES - ENY)RONI�NTAL HEALTH DAMbLam <br />UNOERCR STORAGE TANK PROGRAM <br />I <br />FACILITY SITE NAME <br />-FEE WORKSHEETS <br />T <br />FACILITY CONTACT NAME <br />(��� <br />E <br />FACILITY ADDRESS <br />MA --T <br />!`F <br />s <br />SITE PHONE r.(th AREA CmE <br />(/� �(�J ` <br />CITY <br />-� <br />=-? L1 U <br />A <br />STAB ZIP-�cme.��./ of TANKS <br />SITE/ <br />P <br />L <br />APPLIGNT/81`yLr{p'MC NAME <br />at <br />a <br />C ` APPLICANT TAR <br />I <br />I <br />! I U �� <br />�J (T <br />C <br />RAILING ADDRESS <br />L - <br />h <br />V <br />h APPLICANT PRM1 WITH AREA CODE_ <br />�J V <br />N <br />T <br />CITY �� <br />STATE ZIP .. TYPE of APPLICATId".(� <br />53 (Closure, [naLllatlon, <br />�/I <br />e.)� <br />TOTAL <br />ANNUAL FACILITY FEE (Prior <br />to jw",y 1, 1991) • 5100.00 1966 1987 1985 1989 <br />1990 <br />A <br />C <br />i <br />X 00 /00 <br />FACILITY PENALTY FEES ASSESSED ((} Applicable) <br />p o s o o <br />gQos� <br />I <br />V <br />TANK FEE • S50.00/TAHK <br />boa boa p� D0 � 5 d d <br />r <br />(Prior to Jaruery 1,19917 <br />9901 <br />E <br />S170/TANK (After Jarwry 1, 1991) <br />F <br />R Tanks • <br />(molt 1ply i by fee for <br />1986 1967 1958 1989 1990 1991 1992 199! 199< 1995 <br />1996 <br />each year appl lesblq <br />X �—� �� �� <br />17O /r7 <br />I <br />L <br />TANK PENALTY FEES ASSESSED <br />)0oo( 700a <br />1 <br />T <br />STATE Sl1RCRARGE • 556 ,00 each TAMX (Due wary S years) See Cal lfomfs H i S Cada, Section 25287 <br />T <br />a Tonka A 556.00 <br />(Enter t and year) <br />1986 through 1990 <br />1991 through 1996 <br />v i S h I% <br />C PERMANENT CLOSURE (Reaoval or A <br />L Uthor(Zed Closure -fn -Place) TANK T.D. /(q <br />D CLOSURE FEE + !78,00/hour (3 hours etiniauoMK)/TA <br />S IF TANK(a)_ % f2U,00 . S <br />U TE)PCRART CLOSURE (Pian Reviewd [ropectiam) <br />R TANK I.D. f(a) <br />E TEMPORARY CLOSURE FEE a 178.00/hour (3 hard ainimua/FACILITT) ,)0 minfsaa <br />S <br />P INSTALLATION PLAN CHECK (Plan RevieN A C"truetion Inspections) TANK I.O. t(a) <br />L <br />A <br />N PLAN CRECK FEE • S78,00/how IS hours miniehmyFACILITY) <br />1624.00 ■tntshua f <br />R REPAIR fEE (Uorkplan Review i Cantruetion Irrpeotioru) TANK I.D. 1(s) <br />E <br />P TANK LlN1MG REPAIR FEE + 278-00/hour (3 hours alninn/TARK) R TANK(a) K x.00 , <br />A f <br />I tANX RETROFIT REPAIR FEE • f78.00/how (3 hours •In./FACILITT) • 3234-DO <br />mi <br />R S <br />PIPING REPAIR FEE • 2781-00/hour (3 hours ofnfa WFACILITY) • f23A.00 Minlaaw <br />5 <br />N TRANSFER FEE •520,00 UNAUTNORIZEO RELEASE EVALUATION • f78.00/hr <br />1 <br />S <br />C CONSULTATION FEE • f7S.00/hr SAMPLING INSPECTION FEE • f78.00/hr <br />TOTAL DUE <br />FOR OFFICE USE OMIT __ /" <br />i1 jh�•��si.•iT+i�••—ir�rss`�Cs Ci=.►������G�wii���� <br />T Ufsr� �y%Jt1Mi �1�lets�et�ts <br />a aCGt1 VED dT <br />-- SIS <br />�� �_ f <br />s••a•ss rs saieww'a'sehs�issia�rsa�ww.ianrii�iti�.ii.sia�i, <br />EN 23 032 fREYfSEO 3-1-951 Paas it <br />'> J <br />1_Y` , <br />S <br />f <br />f <br />LL <br />p72�1 <br />1 <br />