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SAN "QUIN MINTY PIRILIC HEALTH SERVICES - ENVIRONMENTAL BERLIN DIVISION <br /> UNDERGR(R)ND SIORAOE TANK PROGRAM - FEE IIORKSHEET <br /> ' FACILITY SITE NAME Don Rodgers FACILITY CONTACT NAME Don Rodgers <br /> E FACILITY ADDRESS 550 W Chater Wa SITE PHONE / with AREA CODE N/A <br /> A �Ily STATE LIP CODE R e( LANK! <br /> A et 411E <br /> CA 992 <br /> P --- — APPLICANT CONTACT NAME <br /> APrucaxr/RutixO xDon Rodgers Don Rodgers <br /> ---- -- <br /> C MAILING ADDRESS APPLICANT PHONE R WITH AREA CODE <br /> A 11900 S. Union St. <br /> M CITY SLATE 15C3�Ej (Closure Plnetellstlon, eeo.)renroval <br /> Manteca, lA J <br /> TOTAL <br /> T(After <br /> 88 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January I, 1991) 1100.00 ! <br /> A xxx <br /> C — s <br /> 1 FACILITY PENALTY FEES ASSESSED (If Applicable) xxx <br /> I <br /> V TANK IEE = 250.00/LANK (Prior to Jnrwary 1,1991) 0170uery 1, 1991) <br /> 1986 1987 1988 1989 1990 199194 1995 1996 <br /> R tanks = <br /> r (multiply /-6y'-fee for f <br /> A each year applicable) <br /> IT <br /> xxxx xxxx <br /> 1 TANK'PENALTY FEES ASSESSED <br /> IT %%X% %NK% ! <br /> I. <br /> I STATE SURCHARGE _ 156.00 each TANK (Due every 5 years) See California H A 1 Code, Section 25287 <br /> 1 I Tanks x 156.00 1986 through 1990 199) through 1996 <br /> (Enter mmart and year) ! <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. /(a) <br /> U CLOSURE FEE = 178.00/hour (3 hours minimim/tANK) N TANK(s)1_ IT 5234,00 12 4.00 <br /> U TEMPORARY CLOSURE (Plan Review A Inspections) TANK I.D. I(a) <br /> R ---- <br /> E TEMPORARY CLOSURE FEE - 478.00/hour (3 hours minimun/FACILITY) 5234.00 minimum t <br /> P 14SIALLAIION PLAN CHECK (Plan Review A Construction Inspections) TANK I.D. /(s) <br /> L — <br /> A <br /> N PLAIT CHEC1 IEE = 170.00/hour (8 hours mhTimum/FACILITY) = t624.00 minimum 4 <br /> E REPAIR FEE (workplan Review A Construction Inspections) TANK I.D. I(s) <br /> P tANK UNINO REPAIR FEE = 478.00/hour 0 hours minimum/TANK) / TANK(s) IT 1234.00 • S <br /> 1 IAHK RETROFIT REPAIR FEE = 178.00/hour (3 hours min./FACILITY) a 0234.00 minimum S <br /> R _—__ <br /> PIPING REPAIR FEE 478.00/hour 0 hours mini"/rACILITY) = t234.00 minlmu, 1 <br /> NJ IRANSrER FEE - Sam UNAUTHORIZED RELEASE EVALUATION - !78.00/hr t <br /> I <br /> S -- <br /> c CONSULTATION FEE + 1178.00/hr SAMPLING INSPECTION FEE - 178.00/hr f <br /> TOTAL DUE 1234.00 <br /> �!I i !NilSIFGm n:!!a:,m n I p!tm!m nirn....... n!tmm�mrnm noon n.m m�uumneum!m!nn n!n n n!nm n ntnnmmm!n i n m m n n i i i i n i i i i n n m i <br /> I I �. I 16 I I, <br /> 4u€�� +�G►� , ,,: rs� ". 614p°�66� <br /> IIQInIq, 191! IIS �II!Ilnn !i�mll I! �� IIIIII'll�lln�I�����n������� ini iinn.i }min nnininninm �mi.nniiiiii minmi i um�iii i � iin n in in i i i i n i I <br /> .9 '�Li.h.iIIIIJ...e�.i91.iIJeJI.TIL,9mIJJl�..�...i..i.i.n�i�.�'JiVInillun6661iC11166�6111iIInniIInI�IIIImnlillulllu6nVnll�nilminl9VVm�uul�lili666116n161nm6CIJ1nVPnI�IiIVIIIIIiIIIJll61n16i8@l�ll�hl6illli�6unm,m�lr�um�����l�mllammm�m,�nm�ri <br /> EN 23 032 (REVISED 4-29.94) Page 11 <br />