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SAN JOAOUIN COUNTY PUBLIC HEAL'N SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> uNDERGACIIND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F Rays Beverage C:o. Dave Guidi <br /> A <br /> C SITE PHONE B with AREA CODE <br /> 1 FACILITY ADDRESS 4218 N. Coronado Ave. (209)466-6883 <br /> I �rATE ZIP CODE R of TANKS 1 <br /> T CITY Stockton, Ca 95204 at SITE <br /> Y <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> r Dave Guidi <br /> P Rays Beverage Co. <br /> 1 NAILING ADDRESS O /?oX �f/a� APPU CANT PHONE R WITH AREA CODE <br /> (209) 466-6883 <br /> A STATE ZIP CODE TYPE of APPLICATION <br /> N CITYINSTALLATION, ate. Removal <br /> I Stockton, Ca. 9520 CLOSURE, <br /> TOTAL <br /> A 1986 1987 1988 1989 1990 <br /> C <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) _ $100.00 5 <br /> 1 <br /> V <br /> E TANK FEE 550.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F 9 Tanks * 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply %by fee for S <br /> C each year applicable) <br /> 1 <br /> L STATE SURCHARGE = 556.00 each TANK (Due every 5 years) See California H b S Code, Section 25287 <br /> I <br /> T R Tanks x 556.00 1986 through 1990 1991 through 1996 <br /> Y (enter ;;amt and year) 5 <br /> PERMANENT CLOSURE (Removal or Authorized Closure-In-Place) TANK I.D. 5(a) <br /> C <br /> L CLOSURE FEE = 253.00 per hour (3 hours mi nimua per TANK) 0 TANK(s)� K 5159.00 • 5159.QQ <br /> O <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. B(a) <br /> R <br /> E TEMPORARY CLOSURE FEE • $150.00 each TANK R TANK(S) _ K $150.00 5 <br /> P PLAN CHECK (Install. Plan Review 6 Construction Inspections) TANK I.D. 5(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours mini" per Facility) = S424.00 minimus 5 <br /> R REPAIR FEE (workplan review A construction Inspections) TANK LD. 5(s) <br /> E <br /> P TANK REPAIR FEE = 553.00 per hour (3 hours mfninWTANK) A TANK($) K $159.00 = 5 <br /> A <br /> I <br /> R PIPING REPAIR FEE • $53.00 per hour (3 hour mini sus per facility • $159.00) $ <br /> M CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> S <br /> C FEE = 553.00/hr FEE _ $53.00/hr FEE = S 53.00/hr <br /> I TOTAL DUE <br /> OFFICE USE ONLY s 159,0 <br /> wwr=rrwrw,rwr.i.,:»w=wiw»w4w ww w=wi,ww=w.w wrwr waw w»w:r»sr,w wrr w=w wrw r=wii3 i.,..ri' ..•••••••.•._.._.......... <br /> *a■ <br /> TtdE"c'!4s '°KT�1"iflfE• <br /> :"•sAE"E54t 1►`" c@II(QI R x"A1�lA�"1ECtlU'"` EA€ "d7t'tlft" }EELIE"ft [f"HP`•` " "VXT�"RE��R�EU""'a.s <br /> ■ <br /> s /59. cu C1er S���yz <br /> ...__._.... S[�Nz ..... � ................... _ . ... .............; <br /> www»='= ......_•___ __..._........... ....... ........._. ........«........................ ..._ ...«...... .._ <br /> • wawwar ... ... wwwiwaiwrwrrSrr.,«: <br /> mrwa,.•rmesrswaw«rwarrrwwr'i�iswwie+r.a«iw ns zdw+w wwsras a>««rawrrrmaawaerw- —ssamaawsaawaswarsawwaaw amwwra�sswm:.=a iw <br /> EN 23 032 (REV 1/10/91) it Paoe 11 `� <br />