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CNTY <br /> BLIC HEALTH <br /> SAN JDAENVIRONMENTALU VICES <br /> HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY CONTACT NAME <br /> FACILITY SITE NAME <br /> FRT1F1 I A• �R FT AI . <br /> A <br /> C �CJ�� qqo SITE PHONE k with AREA COD <br /> f��J� �Y VIILSON WAY STATE Z � Q Y of TANKS <br /> � TW <br /> T CITY STOCKTON U') at SITE <br /> Y <br /> APPLICANT CONTACT NAME <br /> A APPLICANT/81LLING NAME <br /> P <br /> P <br /> L APPLICANT PHONE it WITH AREA CODE <br /> I MAILING ADDRESS <br /> C <br /> pSTATE Z E TYPE of APPLICATION VAL <br /> N CITY CLOSURE, INSTALLATION, etc. <br /> T <br /> TOTAL <br /> A 1986 1987 1988 1989 1990 <br /> C $ <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) _ $100.0 <br /> V $170/TANK (after January 11 1991) <br /> E TANK FEE = $50.00/TANK (prior to January 1,1991) <br /> F Y Tanks = 1986 1987 1988 1989 1990 1991 1,992 1993 1994 1995 1996 <br /> A (muLtiply i-6y—fee for $ <br /> C each year applicable) <br /> I <br /> L STATE SURCHARGE _ $56.00 each TAXK (Due every 5 years) See California HIL; Code, Section 252 <br /> 87 <br /> I 1986 through 1990 <br /> through 1996 <br /> T Y Tanks_ x $56.00 $ <br /> Y (enter mlolYl[ end year) <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Piece) TANK I.D. 1(s)_ $ <br /> C <br /> L CLOSURE FEE = $53.00 per hour (3 hours minimum per TANK) Y TANKS) 5159.00 <br /> X = <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time Permit, for review/inspections) TAMC I.D. s) $ <br /> R0 TANK(s) X $150.00 = <br /> E TEMPORARY CLOSURE FEE 111; $150.00 each TANK <br /> P PLAN CHECK (Install. PlM Review 8 Construction Inspections) TANK I.D- !(s) <br /> L <br /> hours mininum per facility)p $424.00 mini mum $ <br /> N PLAN CHECK FEE 553.00 per hour (8 <br /> R REPAIR FEE (workplan review d construction Inspections) TAMC I-D. !(s) <br /> k TANK(s) <br /> E X $159.00 = $ <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minirtum/TANK) <br /> A $ <br /> R PIPING REPAIR FEE = $53.00 per hour (3 hour minimum per facility = $159.00) <br /> M TRAXSFER FEE 520.00 UNAUTHORIZED RELEASE EVALUATION = $53.00/hr <br /> f <br /> S <br /> C CONSULTATION FEE = 553.00/hr SAMPLING INSPECTION FEE = 553.00/hr <br /> TOTAL DUE $ <br /> 91:�1GF.SISE�tHLY -- _� <br /> ���-: C AE TC'�' CErC�D�'Bl AT ECEiOEI�� <br /> A <br /> EH 23 032 (Revised 4/8/91) Page 6 <br />