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AUtN COUNTY <br /> C HEALTH <br /> Snn`,dENVIRONMENTAL HEAV10E.� <br /> LTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM -FEE WORKSHEET <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> Thor2g._ <br /> Tri Star Homes, LLC <br /> T SITE PHONE A with AREA CODE <br /> E FACILITY ADDRESS 1325 N. Corral Hallow Rd. <br /> 9 STATE ZIP CODE 0 of TANKS <br /> CITY at SITE <br /> A Trac <br /> P APPLICANT/BILLING NA APPLICANT CONTACT NAME Kelly Thorpe <br /> Tri Star Homes, LLC <br /> 1 APPLICANT PHONE 9 WITH AREILCOOES39-2890 <br /> MAILING ADDRESS P.O. BOX 1056 �ZL�7�y1 <br /> N CITY STATE ZIP CODE TYPE of APPLICATION <br /> Alamo, CA 94507 !Closure, Inatatlatian, etc.) Removal <br /> TOTAL <br /> A TANK FEE _ %50.00/TANK (Prior to January 1,1991) 9170/TANK (After January 1, 1997) <br /> C Et" <br /> 1987 1988 1989 1990 )991 1992 1993 1994 1995 1996 <br /> T 9 Tanks = <br /> I (multiply )t-6Y—fee for 9 <br /> Y each year app!lcabl e) XXXX %%%X %XX% %X%X <br /> E 9 <br /> TANK PENALTY FEES ASSESSED XXXX X%%% XXXX XXX% <br /> 5 <br /> t STATE SURCHARGE = 956.00 each TANK (Due every 5 years) See California N 6 S Code, Section 2528 <br /> F 9 Tanks_ x S56.00 1986 through 1990 1991 through 1996 <br /> (Enter amount and year) X X 9112.00 <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. R(s) <br /> 0 CLOSURE FEE = 978.00/hour (3 hours mininum/TANK) R iANK(!)2_ x (234.00 9468.00 <br /> 9TANK I.D. R(s) <br /> U TEMPORARY CLOSURE (Pion Review 6 Inspections) <br /> E um mum TEMPORARY CLOSURE FEE = 978.00/hour (3 hours minim /FACILITY) $234.00 mini9 <br /> P1 INSTALLATION PLAN CHECK (Plan Review A Construction Inspections) TANK I.D. /(s) <br /> N PLAN CHECK FEE = 578.00/hour (8 hours mininun/FACILITY) = E624.00 mininum 9 <br /> R REPAIR FEE (Workp(an Review 8 Construction Inspections) TANK I.D. R(s) <br /> P TANK LINING REPAIR FEE = 978.00/hour (3 hours minimum/TANK) 0 TANK(9) K 9234.00 • 9 <br /> A — S <br /> I TANK RETROFIT REPAIR FEE _ $78.00/hour (3 hours min./FACILITY) = $234.00 minimum <br /> R5 <br /> PIPING REPAIR FEE = 978.00/hour (3 hours mininam/FACILITY) _ $234.00 min(nxm <br /> "I TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION - 1781 9 <br /> t <br /> 9f <br /> C1 CONSULTATION FEE _ $78.00/hr SAMPLING INSPECTION FEE = 578.00/hr <br /> TOTAL DUE 5£30.00 <br /> :!aFmtUN-1.,OFFICESE UQNLI-rm�rm8egma�n;m.=.!..�emarmnlm�lm�a�tr.imammrne:�:m�;r:�rrma�msta�nmalme m <br /> mm�nn m�"n'III <br /> .. <br /> NIEPT �CdGPU E# # tai nD$ I IT � <br /> IFinnlmmmm'nllmnmmmn MI.MOM 1 fi �mamp� <br /> 7.., Pti� 'TS ...:..vu.__T:P _53._. _i.w Rl F"IP-'L@2^.�9 'Ibnn"111,Ind[119'I: <br /> . . .......... . .:.. . _..._. _....y ..._... <br /> EH 23 046 (Revised 9/11/96) Page 11 <br />