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SAN JGWIN COUN71,_aLIC HEALTH SERVICES - ENVIRONMENTAL HEALT__�/VS:ON <br />.1e rAwr MnC21w . 999 Un2rSHEET <br />I <br />FACILITY SITE NAME FACILITY CONTACT NAME <br />$I <br />I <br />RO Tile La3zeer Th nr'Nn cnn <br />T <br />'EI <br />n <br />SI(72 �4'1?1 DE <br />AOCRESS <br />II <br />FACILITY )E3x6 <br />310 N. Cluff Ave. I <br />N: <br />STATEN <br />ZIP =E <br />C or TANKS <br />xxxx <br />CITY I <br />Lodi <br />CA <br />1 95240 <br />1 at SITE 1 <br />A <br />A <br />P <br />P <br />APPLICANT/31LL:NG NAME <br />APPLICANT CONTACT NAME i <br />L <br />Lavor Thompson <br />Lavor Thom <br />IAPPLICANT <br />?NONE 1 41TM AREA CODE <br />C <br />MAILING ACCRESS <br />310 N. Cluff Ave. <br />I (209)369-4751 , <br />Al <br />xxxx I <br />xxxx i <br />N�� <br />T� <br />TYPE or AP1 <br />S E . APPLICATION <br />I <br />TI <br />C:TY Lodi <br />j�TEI �2 (C;osure, Ins:altatien, etc.) Removal if <br />I <br />TOTAL <br />I <br />j 1SE6 <br />11587 11988 <br />11989 <br />II <br />1990 <br />L'7Y FEE (Prior to <br />ANNUAL FAC:xxxx <br />.anuary 1, 1991) = S100.00 <br />xxxx <br />I xxxx ;xxxx <br />I <br />xxxx I <br />xxxx i <br />s xxxxxxxx <br />A <br />L <br />( xxxx <br />XXXX <br />xxxx I <br />xxxx i <br />1 xxxxxxxx <br />T� <br />FAC:Li TY PENAL'.Y FecS ASSESSED CIF Ape!icaole) <br />II <br />(Prior to January 1,1991) <br />5170/TANK <br />CA':er <br />January <br />1, 1991) <br />V <br />TANK FEE = 550.00/TANK <br />E <br />11991 <br />11992 <br />� 1993 11594 <br />11995 <br />1996 11957 <br />11998 <br />9 Tanks = 11588 <br />11989 11990 <br />F <br />(multiply 3 ey fe-_`or <br />5 <br />A <br />each year acplicab(e) <br />XXXX I XXxX I XXXX <br />I xxxx <br />IxxXX <br />C <br />'AHK PENAL"Y FEES ASSESSc <br />� XXXX � XXXX I XXXX <br />I XXXX <br />IX%XX <br />I <br />I <br />� I <br />5 <br />iII <br />L,S <br />t( <br />STATE SURCHARGE FOR NE'4 FAC LiTIES ONL".=118.50 <br />T' <br />T <br />d Tanks_ x 18.20 <br />1988 through 1993 <br />(556) <br />1593 <br />through <br />1997 (356)� <br />1998 <br />( <br />j) <br />1 I <br />SURCHARGEFOR 1998 xxxxxxxxxxXxxxxxxxxxxxxxxxx %XXXXXXXXXXXXXXXXXXXXXX <br />CPERMANENT CLOSURE (Removal or AUtheri] d Closure -in -Place) I TANK :.0..(s) <br />Ll <br />- <br />OI CLOSURE FEE = 178.00/hour (3 hours minimum/TANK) S TANKIS) 1 X SZ34.00 <br />S <br />U) TEMPCRARY CLOSURE (PLan Review L Insmec:ions) i TANK 1.0. +(s) <br />R, <br />El TEMPORARY CLOSURE FEE = SrE.00/hour (3 hours mini"/FACILITY) � 5234.0C Mini MUM <br />Pi INSTALLAT2LN PLAN CHECK (Plan Review 3 Construction Inscections)I TANK 1.7. :(s) <br />L <br />A <br />NI PLAN CHECK FEE = 578.00/hour (3 hours minimum/FAC:LITY) = 5624.00 mininxm <br />RI REPAIR FEE (Verkplan Review S Ccns:r_c:ion Inspections) TANK (.0. :(5) <br />E; <br />P TANK L1N:NG REPAIR FEE = 578.00/hour (3 hours minimum/TANK) Y TANKS) X 1234.70 = <br />A <br />I TANK RETRCFIT REPAIR FEE = 5-,8.00/hour (3 hours min./FACILITY) = 5234.70 minimum <br />R <br />PIPING REPAIR FEE = 578.00/hour (3 hours mini"/FAC:L.TY) = 5234.00 mininxm <br />Mj TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUAT:CN = 578.00/hr <br />CI CONSULTATION FES = 578.00/hr I SAMPLING tNSPECTICN FEE = 578.00/hr I� <br />CE USE ONLT <br />S S COMPUTER S <br />9N 7; nl-0 (RFVNSF0 1.12-98) <br />C IST CGDE <br />S <br />TOTAL DUE <br />3Y <br />1234.00 <br />1 <br />S <br />