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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIROIOENTAL HEALTH DIMON <br /> LMEF----9p STORAGE TANK PROGRAM - FEE WORKSHEET <br /> S FACILITY SITE NAME �'� FACILITY CONTAC a,IAME <br /> T 4 R __L k i G . L6�7.�ij'tJ S�aivc PG <br /> 3 � /FACILITY ADDRESS St NONE # with AREA CODE <br /> A CI1Y G / -jfATE ZIP CODEO at of TA <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> • <br /> ItREPAIR FEE (Workplan Review S Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE - S78.00/hour (3 hours minimum/TANK) # TANK(s) _ X 5234.00 • S <br /> A <br /> 1 TANK RETROFIT REPAIR FEE - 578.00/hour (3 hours min./FACILITY) = S234.00 minimus f <br /> R <br /> PIPING REPAIR FEE = 578.00/hour (3 hours minimua/FACILITY) = 5234.00 minimus f <br /> M TRANSFER FEE . $20.00 I UNAUTHORIZED RELEASE EVALUATION = $78.00/hr S <br /> S <br /> C CONSULTATION FEE _ $78.00/hr SAMPLING INSPECTION FEE _= 578.00/hr f 7 CJ� <br /> f-0 TOTAL DUE 5 <br /> FOR OFFICE USE ONLY _ <br /> SWEEPS # I COMPUTER it I LOC CODE I DIST CODE AMOUNT RECEIVED I ECK CASH I RECEIVED BY I DATE RECEIVED <br /> ADART I 9 9 � s 7 � 5 97�L 01 a4 I <br /> EH 23 032 (REVISED 11-1-92) Page 11 <br />