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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> _ RGROUND STORAGE TANK PROGRAM - FEE WIKSHEtr— <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> A J. I. Case Cor oraton Doug Johnson <br /> C <br /> I FACILITY ADDRESS SITE PHONE 0 with AREA CODE <br /> L 1234 Charter Way 800/692-3460 <br /> ofI <br /> Y CITY Stockton STATE 2IP5(:ODE at SITENKS 3 <br /> A APPLICANT/BILLING NAME CN Y LUbAPPLICANT CONTACT HAME <br /> P <br /> P Don Lambert 6 Sons, Inc. Blake L. Lambert <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE 0 VITH AREA CODE <br /> C P.O. Box 659 (209) 874-2168 <br /> A <br /> N CITY STATE ZIP CODE TYPE of APPLICATION <br /> T Waterford CA 95386 CLOSURE, INSTALLATION, etc. Closure <br /> TOTAL <br /> A <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) - $100.00 <br /> 1 2 <br /> V <br /> E TANK FEE = S5b.00/TANK (prior to January 111991) 5170/TANK (after January 1, 1991) <br /> F 0 Tanks = 1986 1 1987 1 1988 1 1989 1990 1991 1992 1993 1 1994 1 1995 1 1996 <br /> A (miltipty # by fee for <br /> C each year applicable) 2 <br /> I <br /> L STATE SURCHARGE - $56.00 each TANK (Due every 5 years) See california H t S Code, Section 25287 <br /> 1 <br /> T 0 Tanks x 556.00 1986 through 1990 1991 through 1996 <br /> Y (enter amo,nt and year) <br /> S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. 0(s) <br /> C <br /> L CLOSURE FEE - S53.00 per hour (3 hours minimum per TANK) 0 TANK(s) X 2159.00 <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. 0(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = S150.00 each TANK 0 TANK(s) X $150.00 - S <br /> P PLAN CHECK (Install. Plan Review b Construction Inspections) TANK I.D. 0(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - S53.00 per hour (8 hours minimum per FaclLity) = 2424.00 minimum S <br /> R REPAIR FEE (workplan review b construction inspections) TANK I.D. 0(s) <br /> E <br /> ' P TANK REPAIR FEE = S53.00 per hour (3 hours minlnWTANK) 0 TANK(s) X $159.00 = S <br /> A <br /> I <br /> R PIPING REPAIR FEE = S53.00 per hour (3 hour minimum per facility = 2159.00) f <br /> M CONSULTATIONS 11NAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> S <br /> C LFEE = 253.00/hr FEE = 553.00/hr FEE e 253.00/hr <br /> TOTAL DUE [LI59.00 <br /> OFFICE USE ONLY <br /> rw'aw:wiwiwwwwww <br /> aAiwAAP TOC 1ST`CCVtiQJ{r�"1CCEES" fAE'�It A/C'iII " N[L'E(OEff"�P"'""` u/T �Tl�Ef3^w <br /> a 2 A <br /> A <br /> wwwwwwwwwwwwv�r'rTw vi.wnCaiv7,riwoC.:r.:wr.«:.iwrwrwwwwwwww,.:in'w.wrwyu.�iw wy�wnnu�.wvnyww»wwr.w <br /> 1M AIAaRAAAaItAfAA1AA MifYMYI ANI M1if1YI AAIAAAAIfYRaRLMY1AAfM411aAIM=MiilllaM MlMf1a YYIMIt}1eM AAMAlalAORAAAAeM1YtAAAA MYIaM'MYA+YYifMli}MMOfwfRlwAl[A/ <br /> EN 23 032 (REV 1/10/911 ft Paoe 11 <br />