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' SAN JOIQUIN COUNTY PUBLIC HEALTH SERVICES - FNVIROMIll IIFAI_TN DIVSIOT <br /> INIDERGROLAN) STORAGE TANK PROGRAM - FEE tX1RKSNEFT <br /> x <br /> it Si1E NAME FAT CONTACT NAME <br /> S & R RANCH DEWITT ( 209 )948-6124 <br /> ILIYY ADDRESS OT R vIth AR )I,CODE <br /> 10717 COLLIER RD 91333-14 _, <br /> A CITY STATE 21D CODE N of TANKS <br /> ACAMPO CA 195220 at sltE ONE ( I ) <br /> P APPLICANT/NILLINO NAME APPLICANT CONTACT NAME <br /> L WESTERN METER SERVICE, INC. JACK DEWITT <br /> C MAILING ADDRESS APPLICANT PHONE N WITH AREA CODE <br /> A @&1)$ TEEPEE DR. , STE. E ( 209) 948-6124 <br /> M <br /> T CITY STATE ZIP CODE TYPE of APPLICATION <br /> STOCKTON CA 95205 (Closure, Instnitation, etc.) <br /> TOTAL <br /> 1986 1907 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prier to January i, 1991) + !100.00 <br /> A t <br /> C _ <br /> T FACILITY PENALTY FEES ASSESSED (If Applicebte) xxxx xxxx f <br /> V TANK FEE a 150.00/TANK (Prior to January 1,1991) 4170/TANK (After January 1, 1991) <br /> E <br /> N Tanks a 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 _1996 <br /> F (multiply %byby fee for <br /> A each year apptieabte) -- <br /> C <br /> 1 TANK PENALTY PEES ASSESSED xxxx xxxx s <br /> L <br /> 1 STATE SURCHARGE a 156.00 each TANK (Due every 5 years) See Catlfornis H A S Code, Section 25287 <br /> T <br /> T R Tanks it 156.00 1986 through 1990 1991 through 1996 <br /> (Enter arlr t and year) <br /> s <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-In-Ptace) TANK I.D. pis) <br /> L <br /> 0 CLOSURE FEE a 178,00/hour (3 hours minimtm/TANK) LTANK <br /> ) 1 x 4234.00 a f 3 - <br /> S <br /> U TEMPORARY CLOSURE (Plan Review A Inspections) . A(a) _ <br /> R <br /> E TEMPORARY CLOSURE FEE a 178.(10/hour (3 hours minInua TANK) N TANK(s) X !234.00 t <br /> JA INSTALLATION PLAN CHECK (Plan Review S Construction Inspections) TANK I.D. N(a) <br /> PIAN CHECK FEE • (78.00/hour (8 hours mtnimlzn/FACILITY) * $624.00 minimm 4 <br /> R REPAIR FEE (Vorkpten Review R Construction Inspections) TANK I.D. #(a) <br /> — <br /> P <br /> P TANK LINING REPAIR FEE a SlF&DO/hour (3 hours minimza/TANK) N TANK(s) X 4234.00 <br /> A S <br /> I TANK RETROFIT REPAIR FEE a 178.00/hour (3 hours min./FACILITY) a 1234,00 miniaum S <br /> R <br /> PIPING REPAIR PEE s 478.00/hour (3 hours minimAA/FACILItT) a 1234.00 mini" 1 <br /> N TRAN4fER FEE ■ 420.00 UNAUTHORIZED RELEASE EVALUAtION = 478.00/hr S <br /> s — <br /> C CONSULTATION fit a 478.00/hr SAMPLING INSPECTION FEE - 178.00/hr 4 <br /> S <br /> J� [OtAL DUE 1 <br /> FOR OFFICE USE ONLY - ( L 6 L � 1 <br /> � �� �SwEEP4 R CDNPIITER NOr'wmmi i0r�rm n nriirin�irninnu it r i� r i�r' :nn t n�i rn�: :fur n� n m u'n hni �r.n rn iiir Ia: mMW mm, Ii°ri : vvmnm� <br /> RECEIVED BY DATE RECEIVED <br /> �DmDIST CODE AMOUNT RECEIVED rnua nir <br /> �dxT---- <br /> mreemm„ nrmmm�mmnrrm,.t' FAFr n r r � t' n m rvsl <br /> rrmnranomrmmmlmmmmarnierrn mmnmm�l..nule w r r r, ,.;r n u n r.nmrnn n mr�:v <br /> n rn rr.._Lrnnue I !:r.nnI m: <br /> IN 23 032 (REVISED 11.1-92) Page 11 <br />