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SAN JOAQUIN CO PUBLIC *ALTN SERVICES - ENVIRONMENTAL N 1 DIVSION <br /> u K)ZROROM STORAGE TAMC PROGRAM - FEE WORKSMEEr-W <br /> 5 F,eCILITV SITE NAMEnq '' FACILITY CONTACT NAME <br /> f0 F J 1TPC1 Ihn St& <br /> ` FAC LITY/1DDRE,tf ^ r SITE PNOM fh AREA E <br /> 75 <br /> CITY`IIYJJ)J JF•1H'�� N ST�1J,E*APPL <br /> E R of TANKSL/J(/!� iJ - <br /> A l/./L�L at SITE o(� <br /> P <br /> ICAN COWTP APP�1 <br /> 1 <br /> C MAIL)9 KESS APPLICANT PHONErM WITH AREA CODE <br /> A <br /> Y <br /> ( Sj11TE ZAP CODE TYPE of APPLICATION <br /> T CITY r' <br /> �' (Closure, Installation, etc.) <br /> TOTAL <br /> 1986 1967 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) • S1DO.00 <br /> A xxxx xxxx S <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX xxxx f <br /> I <br /> V TANK FEE 550.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> f Tanks • 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F (multiply N by fee for <br /> A each year applicable) XXXX xxxx S <br /> C <br /> 1 TANK PENALTY FEES ASSESSED Xxxx xxxx S <br /> L <br /> I STATE SURCHARGE • $56.00 each TANK (Due every 5 years) See California H i S Code, Section 25287 <br /> T <br /> Y R Tanks x 556.00 1988 through 1990 1991 through 1996 <br /> (Enter mauv�t and War) <br /> S <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. Ca) <br /> L <br /> 0 CLOSURE FEE • $78.00/hour (3 hours minim-WTANK) M TANK(s) x 5234.00 = <br /> S <br /> U TEMPORARY CLOSURE (Plan Review i Inspections) TANK I.D. R(a) <br /> R <br /> E TEMPORARY CLOSURE FEE • 578.00/hour (3 hours minimuWTANK) / TANK(s)_ X $234.00 = f <br /> P INSTALLATION PLAN CHECK (Plan Review L Construction Inspections) TANK I.D. R(a) <br /> L <br /> A <br /> N PLAN CHECK FEE • 578.00/hour (8 hours minimus/FACILITY) • 5624.00 minimum 5 <br /> R REPAIR FEE (Workplan Review $ Construction Inspections) TANK I.D. R(s) <br /> E <br /> P TANK LINING REPAIR FEE • 578.00/hour (3 hours miniguWTANK) A TANK(s) X $234.00 S <br /> A <br /> I TANK RETROFIT REPAIR FEE • 578.00/hour (3 hours min./FACILITY) • $234.00 minimum S <br /> R <br /> PIPING REPAIR REE • $78.00/hour (3 hours minlesAs/FACILITY) • $234.00 minimum S <br /> N TRANSFER FEE • 520.00 UNAUTHORIZED RELEASE EVALUATION • f78.00/hr S <br /> 1 <br /> S <br /> C CONSULTATION FEE + $78.00/hr SAMPLING INSPECTION FEE • 578.00/hr S <br /> TOTAL DUE f <br /> FOR OFFICE USE ONLYrn: � ,m,�,..,�:: .. ,!!'!m:.::._.::-^:.^^-!-!rr::!:.�;!;;;,m;!,!!;,!; <br /> ................_...... ....._. ....... .. . _......_..... ......_.........::....:.......:...:....,:.+ ..:..+�+..�,:.:...::: ._......... ..:..._.............!:......Tani i...!!.:......_....-.:!r:."^_!!;;;�:!!!!:armema;N <br /> ,mrrxm:-:::::::!!!::n::::annn::r!:!s::::::::-,: w:::!!m!s,m_:.:......,.::_..........a.._....:....!....u..:__.n._...._.... .._,;!:s!!;!!!!a-!!!:!n!!n::a::-:::a!!�:r:!:=ae:!;!:�:::::�::::: <br /> v SWEEPS k COMPUTER R LOC CODE DIST CODE AMOUNT RECEIVED CHECK R/CASH RECEIVED BY DATE RECEIVED <br /> f <br /> ........__.::::-......•., ....::.._:-::.-,:-+ :z: .._...-,:.::::::::::::::: ::m^.!!n:!n:-:,R,,:;-,;!!!;;;;!;!!!er;;K;'!!!�n;s�lmr!;!^=:!r.:::!!!!;;;,!!!!sr.!-ym! �R�!!; ...M UM!. m.rmmi:.:......=.. Win:+.-!..:.+:9:e!:+:�:�!!a^.mr.!!.^.^..^.!!x.mMRS <br /> r......_.....�....... . .. ?m!!!..... .......... ... . <br /> " °—:•:{;_i:_r; ti!iNiP!!9!!!li+lF'v9N�iki:!:�'1i8ii!ii9!F°n!'!+vhuinlN+Il!+rikafii iii:NNin09.dn+...i+rt'.R4+T+Ik:i!I+Nu.i.... !nF9:kmll.!i4_!.H..._N:9 N1!iii.iNn4N ii NIL+fr.:_n+=iF!i!+41!it'i!!It!I+W _9NIIINnCItlP.RitlIMA <br /> EN 23 032 (REVISED 6-21-93) Page 11 , <br />