Laserfiche WebLink
SAN JOAQUIN COUN"PIPUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALAW61VSI0N <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> A Airport Way Lube Don Nathe <br /> r <br /> "E FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> 442 N. Airport Way N/A <br /> CITY STATE ZIP CODE # of TANKS <br /> A Stockton CA 1 95205 at SITE 0 <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L Don and Celia Nathe Don Nathe <br /> I <br /> C MAILING ADDRESS APPLICANT PRONE # WITH AREA CODE <br /> A 1632 Axford Way 029 94 - 1 <br /> N <br /> T CITY STATE ZIP CODE TYPE of APPLICATION Line sample <br /> Stockton, CA 95204 (ctosure, Installation, eto.)Clsr in p ace <br /> TOTAL <br /> 1986 1487 11988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) _ $100.00 <br /> A XXX1( XXXX XXXX XXXX I %XXX S XXXX%%X% <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXX% XXXX XXX% XXXX I XXX% E XXXX%XXX <br /> I <br /> V TANK FEE = 550.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> 9 Tanks = 1988 1989 1990 1991 1992 1993 1994 1995 11996 11997 1996 <br /> F (multiply # by fee for <br /> A each year applicable) XX%)( XXXX %XXX XXXX XXXX $ <br /> C <br /> 1 TANK PENALTY FEES ASSESSED XXXX XXXX XX%X X%XX XXX% 5 <br /> L <br /> I STATE SURCHARGE FOR NEW FACILITIES ONLY-518.50 $ <br /> T <br /> Y # Tanks_ x 58.00 1988 through 1993 (356) 1993 through 1997 (356) 1998 <br /> SURCHARGE FOR 1998 XXXXXXXXXXXXXXXXXXXXXXXXXX% XXX%XXXXXXXXXXXXXXXXXXX $ <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) I TANK I.D. #(s) <br /> L <br /> 0 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X 5234.00 = [j3 4.00 <br /> S <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE _ $78.00/hour (3 hours minimum/FACILITY) $234.00 mini mm S <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections)I TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE _ $78.00/hour (8 hours minimun/FACILITY) = 3624.00 minimum $ <br /> R REPAIR FEE (Workplan Review & Construction Inspections) I TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE _ $78.00/hour (3 hours minimum/TANK) # TANK(s) X 5234.00 = S <br /> A <br /> I - TANK RETROFIT REPAIR FEE _ $78.00/hour (3 hours min./FACILITY) _ $234.00 minimum S <br /> R <br /> PIPING REPAIR FEE = 578.00/hour (3 hours minimun/FACILITY) = E234.00 minimus S <br /> N TRANSFER FEE _ $20.00 UNAUTHORIZED RELEASE EVALUATION = 578.00/hr I S <br /> I <br /> 3 I ( 5 <br /> C CONSULTATION FEE _ $78.00/hr SAMPLING INSPECTION FEE _ $78.00/hr <br /> TOTAL DUE 32 3 4 .00 <br /> FOR OFFICE USE ONL7 „_— _--— _ <br /> 's . <br /> s <br /> SWEEPS # COMPUTER # LOC CODE DIST LODE AMOUNT RECEIVED CHECK #/CASH RECEIVED BY DATE RECEIVED <br /> ' <br /> __........ <br /> hieT_=4:•v au:ieeei�=-s;SF'�:tip!__lLv:�.—a::::c�.-__:::--.__...._._....__..tv__—�___c_:�ii::i_��—u'aC_.:::..:_ .. .._.. . _..... <br /> FN 71 n1J lRFVISFD 1-12-98) <br />