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SAN JOAQUIN CF 'TY PUBLIC HEALTH SERVICES - ENVIRONMENTAL P IN DIVSION <br />U�GAO W STORAGE TANK PROGRAM - FEE WORKSNEL _ <br />S <br />FACILITY SITE NAME <br />ILITY CONTACT NAME <br />( <br />1988 <br />illie Billingsly <br />rTnr <br />E <br />FA5ydySDA[lrpOrt Way, <br />mill)) AA <br />�i_PM M1N)III. AREA CODE <br />3b`1 <br />L <br />f 702.00 <br />S <br />CITY Stockton <br />`SAATE <br />4ZIPCOIDE <br />R ofTANK 53 <br />A <br />$ <br />A <br />TANK I.D. R(a) <br />et SITE <br />PIPING REPAIR FEE • $78.00/hour (3 hours minimum/FACILITY) • $234.00 minimum <br />f <br />APPLICANT/BILLING NAME <br />LICANT CONTACT NAME <br />1 <br />Inc <br />ou Tvedt <br />C <br />NAILING ADDRESS <br />APPLICANT PHONE R WITH AREA CODE <br />A <br />N <br />269 Oregon St. <br />209-599-2347 / mobile 481-4072 <br />T <br />CITY <br />STATE <br />ZIP CODE <br />TYPE of APPLICATION <br />Ripon, CA <br />95366 <br />(Closure, Installation, etc.) removal <br />TOTAL <br />C <br />PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) <br />1986 <br />1987 <br />1988 <br />1989 <br />1990 <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) • 5100.00 <br />0 <br />CLOSURE FEE • 1178.00/hour (3 hours minimaaa/TANK) <br />1 TANK(s) 3 X $234.00 = <br />f 702.00 <br />S <br />xxxx <br />xxxx <br />$ <br />A <br />TANK I.D. R(a) <br />C <br />PIPING REPAIR FEE • $78.00/hour (3 hours minimum/FACILITY) • $234.00 minimum <br />f <br />E <br />TEMPORARY CLOSURE FEE • 1178.00/hour (3 hours minimum/TANK) <br />M TANK(s) X 5234.00 = <br />t <br />T <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />XX %x <br />t <br />V <br />TANK FEE 1150.00/TANK (Prior to January 1,1991) <br />$170/TANK (After January 1, 1991) <br />E <br />R Tanks • <br />1986 <br />1987 <br />19881989 <br />1990 <br />1993 <br />1994 <br />1995 <br />1996 <br />F <br />(Multiply N by tee for <br />xxxx <br />xxxx <br />fi! <br />S <br />A <br />each year applicable) <br />C <br />I <br />TANK PENALTY FEES ASSESSED <br />xxxx <br />%%%X <br />f <br />L <br />1 <br />STATE SURCHARGE • 1156.00 each TANK (Due every 5 years) See Ce I}ornla N L S Code, Section 25287 <br />7 <br />Y <br />R Tanks x $56.00 <br />1988 through 1990 <br />1991 through 1996 <br />(Enter amount and year) <br />k -- <br />I <br />I <br />S <br />I <br />C <br />PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) <br />TANK I.D. R(s) <br />L <br />A <br />0 <br />CLOSURE FEE • 1178.00/hour (3 hours minimaaa/TANK) <br />1 TANK(s) 3 X $234.00 = <br />f 702.00 <br />S <br />U <br />TEMPORARY CLOSURE (Plan Review L Inspections) <br />TANK I.D. R(a) <br />R <br />PIPING REPAIR FEE • $78.00/hour (3 hours minimum/FACILITY) • $234.00 minimum <br />f <br />E <br />TEMPORARY CLOSURE FEE • 1178.00/hour (3 hours minimum/TANK) <br />M TANK(s) X 5234.00 = <br />t <br />P <br />INSTALLATION PLAN CHECK (Plan Review L Constructior, Inspections) <br />TANK I.D. e(a) <br />L <br />A <br />P <br />TANK LINING REPAIR FEE • 1178.00/hour (3 hours minimum/TANK) <br />N <br />PLAN CHECK FEE • 578.00/hour (8 hours minimum/FACILITY) • $624.00 minimum <br />f <br />R <br />REPAIR FEE (Workplan Review L Construction Inspections) <br />TANK I.D. R(s) <br />E <br />P <br />TANK LINING REPAIR FEE • 1178.00/hour (3 hours minimum/TANK) <br />/ TANK($) x 11234.00 <br />f <br />A <br />1 <br />TANK RETROFIT REPAIR FEE • $78.00/hour (3 hours min./FACILITY) • $234.00 minimum <br />f <br />R <br />PIPING REPAIR FEE • $78.00/hour (3 hours minimum/FACILITY) • $234.00 minimum <br />f <br />r <br />TRANSFER FEE • 920.00 <br />CONSULTATION FEE = 178.00/hr <br />FOR OFFICE USE ONLY <br />LOC CODE <br />UNAUTHORIZED RELEASE EVALUATION • S78.00/hr I I I It <br />SAMPLING INSPECTION FEE _ $78.00/hr f <br />TOTAL DUE f <br />innm rtm r r n .ci num r. rt wnr r rr. m rr^r+nli <br />- <br />DIST CODEI AMOUNT RECEIVED I CHECK R/CASH I RECEIVED BY I DATE RECE <br />f <br />EN 23 032 (REVISED 6-21-93) Page 11 <br />