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SAN JOAQUIN COUNTY PUBLIC HEALTH SERV' <br /> ENVIRONMENTAL HEALTH DIVISION �... <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> A Reynoso Concrete Construction Co . Vincent Reynoso <br /> C <br /> 1 FACILITY ADDRESS SITE PHONE Y with AREA CODE <br /> L 729 So . Commerce Street 209-464-0840 <br /> T CITYt <br /> Y Stockton STATE ZIP CODE Y of TANKS <br /> CA 95203 at SITE 2 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P Oil Equipment Service - Keith A . Tallia <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE NY WITH AREA CODE <br /> G PO Box 950 209-754-1808 <br /> A <br /> N CITY STATE ZIP CODE TYPE of APPLICATION <br /> I San Andreas CA 95249 CLOSURE, INSTALLATION, etc. Removal <br /> A n'✓Q.it(.:n- TOTAL <br /> C 1986 1987 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) • $100.00 1988 1989 <br /> V ICD IW 1 '4V X0 ct-)Is <br /> E TANK FEE = 550.00/TANK (prior to January ~1 5170/ K (after January 1, 1991) <br /> F N Tanks + - 1986 1987 1088 19891990 1991 1992 1993 1994 7995 1996 <br /> A (multiply 0 by fee for G �' <br /> each year applicable) /DU 1(06> ?pv <C-0 <br /> L STATE SURCHARGE + $56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> 1 <br /> T Y Tanks_ X 556.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) <br /> 22Z <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-PLace) TANK 1.0. <br /> C <br /> Ol CLOSURE FEE = S53.00 per hour (3 hours minimum per TANK) X TANK(s) X $159.00 = S <br /> 5 <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. #(a) <br /> R <br /> E TEMPORARY CLOSURE FEE 5150.00 each TANK Y TANK(s) X $150.00 • S <br /> P PLAN CHECK (Install. Plan Review i Construction Itmpections) TANK I.D. R(a) <br /> L <br /> A <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minimum per Facility) = $424.00 minimum S <br /> R REPAIR FEE (workplan reviw L construction Inspec ti oru) TANK I.D. M(s) <br /> E <br /> AP TANK REPAIR FEE • $53.00 per hour 0 hours minimun/TANK) N TANK($) _ X 5159.00 $ <br /> I <br /> R PIPING REPAIR FEE = $53.00 per hour (3 hour minimum per facility = $159.00) S <br /> M CONSULTATIONS UNAUTHORIZED RELEASE EVALUATICIN SAMPLING INSPECTION <br /> I <br /> S <br /> CfEE 553.00/hr FEE = $53.00/hr FEE • S 53.00/hr <br /> TOTAL DUE <br /> OFFICE USE ONLY - - <br /> "`sl"FEE s"2 oi0dr t`o�."'s "'b1's'P+'s" '75+b�5 �c d 'tgEBt'dPc'1 xk'c 7E�b°"8�....• '"ba1'L"R�i''f4 b••,..$ <br /> asrrrraMrr$aa$....rrrwAir aeatr rrarwarrNrwrrrrrrrwa � � `1/ �) U -�. ,,. ' <br /> 1 rr +`Misr$aar�'�"wiwsrrwwarasr�rssrasmrs�rraw <br /> EN 23 032 (REV 1/1/911 7t� �— Pace 11 <br />