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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> J-001ANS SAPALE <br /> I FACILITY ADDRESS SITE PHONE N withREA CODE <br /> L t C oN . - 4 -Z079 <br /> I <br /> T CIT STATE ZIP CODE N of TANKS <br /> Y et SITE ' <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P \ <br /> 5 r 2 — SEl?VECE <br /> I MAILING ADDRESS AP LICANT POE * WIT1� AREA CODE <br /> c 27TE �+ <br /> N CITY TATE IP�O^DE� TYPE of APPLICATION <br /> T S CCK-r� �5 C-W CLOSURE, INSTALLATION, etc. A(_ <br /> A TOTAL <br /> C 1986 1987 1988 1989 1990 <br /> I ANNUAL FACILITY FEE (Prior to January 1, 1991) • $100.00 $ <br /> V <br /> E TANK FEE $50.00/TANK (prior to January 1,1991) %170/TANK (after January 1, 1991) <br /> F $ Tanks • 1986 1987 1 1988 1989 1990 1 1991 1 1992 1 1993 1996 1995 1996 <br /> A (multiply #TiTyfee for <br /> each year applleable) S <br /> STATE SURCHARGE • $56.00 each TANK (Due every 5 years) See California H 6 S Code, Sectlen 25287 <br /> T / Tanks % $56.00 1986 through 1990 1991 through 1996 <br /> T (enter anoint and year) <br /> f <br /> C <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. f(s) <br /> L CLOSURE FEE • $53.00 per hour (3 hours minlinm per TANK) / TANK($)_ X %159.00 • - I,- � l_ <br /> 0 <br /> S <br /> R TEMPORARY CLOSURE (A ane-time permit, for review/Irmpectionm) TANK I.D. !(s) <br /> E TEMPORARY CLOSURE FEE • $150.00 each TANK 0 TANK(s) X $150.00 • f <br /> P I PLAN CHECK (Install. Plan Review 6 Construction Inmpections) <br /> L — <br /> A <br /> H PLAN CHECK FEE - $53.00 per hour (8 hours minierm per Facility) = $424.00 minimm f <br /> E REPAIR FEE (workplan review L construction Inmpections) TANK I.D. I(s) <br /> TANK REPAIR FEE $53.00 per hour (3 hours minlnam/TANK) 11ANK(s) % $159.00 • —r S <br /> R PIPING REPAIR FEE • $53.00 per hour (3 hour miniaua per facility = $159.00) S <br /> TRANSFER FEE !20.00 UNAUTHORIZED RELEASE EVALUATION 553.00/hr f <br /> S <br /> C1 CONSULTATION FEE • $53.00/hr SAMPLING INSPECTION FEE a $53.00/hr TOTAL DUE f <br /> LY <br /> �ya4RN�'e�gryp { x�: F L,J:llpJ �p h� gyaf @yam <br /> ® maNNNN EP',eN�Eanr;a •a-AM6UNI KCVO �l�' 9)Cl1'���'i;N'!NeREI E,�V�Uu;��NticNw,i�em�;OAI NE GE IVE ' <br /> E� ltOJIG:_"�®� I�S�^COO�E���Ner tltlw8GH1N8NN3P`L'diiNNliL1i1311N:N1YIRJ.L153NNT VN'YNINNiiYV SYN <br /> EH 23 032 (Revised 4/8/91) Pape it <br /> �� 1 <br />