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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICE[ - ENVIRORt:NIAL NEALtN DIVEICN <br /> UNDERGRCLAIO 37CRAGE TANK PROGRAM - FEE WDRKSHEET <br /> S FACILITY SITE RAM! <br /> I / ! - FACILITY CONTACT NAME <br /> T T 1 6 C <br /> ! FACILITY ADORE ` SITE PHONE 0 With AREA CODE <br /> L <br /> " <br /> CITY STATE 21► Cort 1 of TANK$ <br /> 2t tl <br /> P C� 5>" 33� to Stn v <br /> P A►n1CARr/EILLItD NAME APPLICANT CONTACT NAME <br /> C HAILING ADDRESS APPLICANT ►HCH! 1 WITH AREA CODE <br /> A P• o . �3�x a 3 of <br /> rcin STATE ZIP CODE Trot eF APPLICATION <br /> °�--+'c �.•� G4 !i 37{, (Clover., I.t.l l.t ien, <br /> TOTAL <br /> ANNUAL FACILITY FEE (Prior to Jarauary 1, 1991) f100.00 1966 Igor 1g6s i 1989 1990 <br /> A <br /> C t <br /> T FACILITY PENALTY FEES ASSESSED (If Applleable) <br /> I )DOOR XXKX f <br /> V TANK f1l • 330.00/7ANK (Prior to Jewry 1,1991) f170/TANK (After Jerwry 1, 1991) <br /> E <br /> / tw*s 0 1986 1961 1%81 1990 1991 1992 1991 1994 1995 1996 <br /> F (multiply I-Visa for <br /> Ceach Year applicable) f <br /> i TANK PENAL IT FEES <br /> ASSESSED KK7O IOIXX t <br /> L <br /> 1 STATE SLACHAAGS . 556.00 each TANK (Due every 5 Y.arf) fee Gllfornl. N A S Cad., section 25267 <br /> T <br /> T t Tanks a 136.00 1%6 through 1990 1991 thretph 1996 <br /> (linter avant and year) <br /> f <br /> C PERMANENT CLOSURE (Iamcvel or Authorlted Closurrin-Pl.ee) TANK I.D. /U) <br /> L <br /> 0 CLOI1Rt FEE • 578.00/hour (1 hours •inlate/TANK) / TANKO)_ X /214.00 f <br /> S <br /> U TOPOART CLOAK! (Plan IevieN t In.peetlGm) TANK I.D. 1(t) <br /> R <br /> E TEMPORART CLOSURE FEt a f78.00/hour (1 hart ■IntaaL/fACILITY) a 624.00 Rfn1maAt ! <br /> NUNN <br /> P INSTALLATION PLAN CHECK (Piet' Rtvfw 8 CdrlstrUCtlan In.iwetiodl tAMK I.O. 1(A <br /> L <br /> A <br /> N PLAN CHECK FEE a 578.00/hour (8 hours RInIs&mVFACtL11Y) a 5624.00 ■Into f <br /> A REPAIR FEE (Yertpl.n tevl.W L ConetrUctlon tr+peetlane) / TAMK I.O, its) <br /> ► TANK LINING Rt►AIR In a (78.00/hour (3 hours Mint AHK) 1 TANK([) X /274.00 . t <br /> A <br /> I TANK RETROFIT REPAIR FE! a 578.00/hour (I h •In./FACILITY) • /274.00 ■InIwA 2 <br /> t <br /> PIPING SIPA11 Ft1 a 478.00/hor (3 noun nlnn/FACILITY) a 62x.00 .Ini.ta S <br /> N 'nAN$Fft FEE a 920.00 ULMAUTINCRIM RELtASt EVALUATION a S78.00/hr S -, <br /> 1 <br /> $ <br /> C CONSULf['TIOIf-ItB->-t7£.b0/hr SANPIING INSMI'10111 Fill • f78.00/hr f <br /> TOTAL DUN f <br /> FO OFFICE USE ONLY <br /> fm�=LT .3 ri—C II .TT�.SGT.3.Z.:.'SQi�EEw�.. ��iiZiL3 ���••�rT�iiw� i1 <br /> 'f7xTmew <br /> ANN <br /> ww���� 3iii=L'S ��A: 33.•'�i.�. �3.T�w—.� .."Z.� .✓G'.r:.�� L��aaTwry�T�A.T LT�.Ti3CAQiQ <br /> ae�iwel�aertell�e>t��e►� 1111E eeW�Yteae`map.e� tAr• er• wttAlAr� �nn�.�aa��� <br /> IN 23 072 (RtVlttO 1-1-931 Paw 11 <br />