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SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH VICES <br /> ENVIRONMENTAL HEALTHDIVISION <br /> UNDE UND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> AFoller <br /> I FACILITY ADDRE S SITE PHONE IN with AREA E <br /> L O <br /> T CITY ST,TE ZIP CODE / of TANKS <br /> T �/} at SITE Cl <br /> AA APPLICANT/BILLING NAME APPLICANT CONTACT NAME AUG 2 4 1992 <br /> P 1-Utfw L <br /> IMAILING ADDRESS APPLICANT PHONE # WITH AREA ODE <br /> I � ENVIRONMENTAL HEALTFI <br /> STATE ZIP CODE TYPE of APPLICATION <br /> T CIT CLOSURE, INSTALLATION, etc. I�G1�M It <br /> TOTAL <br /> A 1986 1987 1 1988 1 1989 1990 <br /> C <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) _ $100.00 $100 $100 5n0 _ 00 f2 f 800.00 <br /> E TANK FEE = 550.00/TANK (prior to January 111 991) $170/TANK (after January 1, 1991) <br /> F # Tanks = 1 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply i-by-fee for f 1080.00 <br /> C each year applicable) 150 f50 $1.00 n,f340 i 5340 <br /> 1 <br /> L STATE SURCHARGE _ $56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> T # Tanks 1 x $56.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) $56 f 112.00 <br /> $56 <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK T.D. #(s) <br /> C <br /> L CLOSURE FEE = $53.00 per hour (3 hours mini" per TANK) # TANK(s)_ X $159.00 = $ <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/Inspections) TANK I.D. !(s) <br /> R <br /> E TEMPORARY CLOSURE FEE _ $150.00 each TANK # TANK(s) X $150.00 = f <br /> P PLAN CHECK (Install. Plan Review 8 Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - S53.00 per hour (8 hours minimum per Facility) = $424.00 minimum $ <br /> R REPAIR FEE (workplan review d construction inspections) TANK I.D. #(s) <br /> E <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimm/TANK) # TANK(s) _ X $159.00 = S <br /> A <br /> 1 <br /> R PIPING REPAIR FEE _ $53.00 per hour (3 hour minimum per facility = $159.00) S <br /> M TRANSFER FEE _ $20.00 UNAUTHORIZED RELEASE EVALUATION = $53.00/hr f <br /> 1 <br /> S <br /> C CONSULTATION FEE = S53.00/hr SAMPLING INSPECTION FEE = $53.00/hr S <br /> TOTAL DUE f 1992.00 <br /> Q;I,F..I;,GE; Snnmmn!nm a m!m <br /> r:!:x!en::.....:�..::.::.. <br /> NEE PS'das <br /> 0'1'E .r DIST CODE <br /> H' <br /> ! <br /> O q 7 I) <br /> ill iZ�y�x����::: ..rn_!!. .i VA./� !(o!md::n Mm!eunan!mmmx:mmr:!�nm!Nn,!!Cm!nM! x�nmAm:mr.,":;,:crev!.=.iii <br /> ............... <br /> :x::x:::ua:!!x:!x!!:;x:aa: r:::mannxmanxex!r!66xxxna!�mm:nmxxnnunnxn!®xaamax!!x:xm:x:nxnmaxwoosnmm�an!ax:nnxxxnxwannxxxnxx!r!maaax:c�xxxau:x:::xaux:x!arm;m:n!a::axxx:ax:.:nxmrd!xnmxr:uvaxx:!:uaxx�xax <br /> EH 23 032 (RE -ft Page it <br /> yolgivzo <br /> AUG 2 4 1992 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> U w <br />