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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F ACCENT PAPER WAREHOUSE Pit FRED D, CLARK <br /> C <br /> I FACI,�.L]Y,(�DDRESS SITE PHONE t with AREA CODE <br /> L / }1 J NIRPORT WAY STOCKTON CA 95205 <br /> Y CIT�TOCKTON TATE zt� atoSITENKS ONE <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P N. FRED D, CLARK . SAME <br /> L <br /> A XAI� VDRE SI�OLLOW AP70n TT1,1�ONF„( tTH AREA CODE <br /> N CI1111._A iSAATE rS1is(000E l/U/)CLOOSURRof APPLICATION <br /> E, INSTALLATION, eteELOSURE <br /> A �'Ull' l.li 7`t �G TOTAL <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to Jarun ry 1, 1991) = 2100.00 <br /> 1 S <br /> V <br /> E TANK FEE = S50.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F C Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply LT <br /> fee for <br /> C each year applicable) S <br /> I <br /> L STATE SURCHARGE - $56.00 each TANK (Due every 5 years) See California H 6 S Code, Section 25287 <br /> 1 <br /> TI 9 Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) 2 <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TAMC I.D. #(s) <br /> L CLOSURE FEE = $53.00 per hour (3 hours minimum per TANK) R TANK(s)_ X $159.00 f <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspectiorts) TANK I.D. !(a) <br /> R <br /> E TEMPORARY CLOSURE FEE = $150.00 each TANK 0 TANK(s) X $150.00 S <br /> P PLAN CHECK (Install. Plan Review & Construction inspections) TAMK I.D. JIM <br /> L <br /> A <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minimum per Facility) - $424.00 minimum S <br /> R REPAIR FEE (workplan review d construction inapectiorn) TAMK I.D. #(s) <br /> E <br /> P TANK REPAIR FEE - $53.00 per hour (3 hours minimum/TANK) / TANK(s) _ X $159.00 = f <br /> A <br /> R PIPING REPAIR FEE = 553.00 per hour (3 hour minimum per facility = $159.00) f <br /> N TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION . S53.00/hr S <br /> I <br /> C CONSULTATION FEE = 553.00/hr SAMPLING INSPECTION FEE - S53.00/hr S <br /> TOTAL DUE 2 59,00 <br /> 41 <br /> �GEEPS�tbF(�6�R� 'GbISE�T5T-C'OCiE-n�AHbbAT-RZGD AE'CK�7C 5 E���-'"'�'D%'i E-BEd�-�"-,�j <br /> - -- - <br /> '.H 23 032 (Revised 4/8/91) CSS Page TW � 2 L���� <br />