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SAN JOAOUIN C( PUBLIC HEALTH SERVICES - ENVIRONMENTAL HE DIVSION <br /> Ulib,'.,ROUND STORAGE TANK PROGRAM - FEE ttWIO.RKSHCCE��EyyT��a LS�AAMM <br /> .) FALALITY SNAMFINCA NOE 1 PARTNERSHIP FLOYbTYSM1TH5(JNE <br /> T <br /> "Fj FACILITY ADDRESS 1611 S. AIRPORT WAY SITE,PHONJE x with AREA CODE <br /> i <br /> 4 <br /> CITY STOCKTON STATE ZIP CODEx of TANKS ONE TO BE REMOVED <br /> P CA 95206 at SITE <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L LA FINCA PARTNERSHIP NO. 1 FLOYD SMITHSON <br /> I <br /> C MAILING ADDRESS APPLICANT PHONE x WITH AREA CODE <br /> A P.O. BOX 1307 (530) 478 6464 <br /> N <br /> T LITY GRASS VALLEY �T�rE 9r51�4�oDE TYPE of APPLICATION !rII 0C I�p <br /> (Closure, Installatitlt� e`C 'r <br /> TOTAL <br /> 1986 11987 11988 1989 11990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br /> A XXXX XXXX XXX% I XXXX I XXXX <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If App(icable) XXXX I %XXX i XXXX XXX% I XXXX S XXXXX%%% <br /> I <br /> V TANK FEE = S50.00/TANK (Prior to January 1,1991) I 5170/TANK (After January 1, 1991) <br /> E <br /> x Tanks = 1988 1969 1990 1991 1992 1993 11994 1995 11996 1997 11998 <br /> F (multip(y x by_fee for <br /> A each year applicable) %XXX XXXX I XX%X I XXXX XXXX I I I I 5 <br /> C <br /> I TANK PENALTY FEES ASSESSED I XXXX XXX% I XXXX I XXXX !XXXX I S <br /> L <br /> I STATE SURCHARGE FOR NEW FACILITIES ONLY=518.50 S <br /> T <br /> T x Tanks x 58.00 1988 through 1993 (556) 1993 through 1997 (556) 1998 <br /> SURCHARGE FOR 1998 1 XXXXXXXX%XXX%XXX%XXXXXXXXXX %X%XXXX%XXXX%XXXX%X%XXX S <br /> C PERMANENT CLOSURE (RemovaL or Authorized Closure-in-Place) I TANK I.D. x(s) <br /> L <br /> 0 CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) it TANK(s) 0NF X 5234.00 = S 234.00 <br /> 5 <br /> U TEMPORARY CLOSURE (Plan Review 8 Inspections) TANK I.D. x(5) <br /> R <br /> E TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/FACILITY) I 5234.00 minimum $ <br /> EAI ATI ON PLAN CHECK (Plan Review 8 Construction Inspections TANK I.D. x(s) <br /> L <br /> HECK FEE = S78.00/hour (8 hours minimum/FACILITY) 5624.00 minimum 5 <br /> R REPAIR FEE (Workplan Review i Construction Inspections) I TANK I.D. x(s) <br /> E <br /> P TANK LINING REPAIR FEE = 578.00/hour (3 hours minim WTANK) I x TANK(s) % $234.00 • 5 <br /> A <br /> I TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = S234.00 minimum S <br /> R <br /> PIPING REPAIR FEE = 578.00/hour (3 hours mininuNFACII[TY) = 5234.00 minimum S <br /> M TRANSFER FEE = $20.00 UNAUTHORIZED RELEASE EVALUATION = S78.00/hr I I S <br /> I <br /> S' <br /> C CONSULTATION FEE = S78.00/hr i SAMPLING INSPECTION FEE = 578.00/hr I 5 <br /> nn , (J' TOTAL DUE 5 2 OO <br /> IXI <br /> VQ x , <br /> � <br /> FOR OFFICE USE ONLY � � _ =e.=.=�:::F_WEIR <br /> —smu:::acDISu:wvu:+i:ui;n'AM <br /> SWEEPS x COMPUTER x LOC CODE DIST CODE IAMWNT RECEIVED I CHECK x/CASX RECEIVED 3Y GATE RECEIVED _ <br /> "C"lern t-17-GA1 - <br />