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SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH TIVSION <br />UNDERGROUND STORAGE TANK PROGRAM - FEE unorsWVCT <br />S <br />FACILITY SITE NAMEFA�CTNJA <br />S <br />ITY COT NAME <br />T <br />Lfi"% j 5 ZJ <br />1990 <br />E <br />FACILITY ADDRESS <br />�0 a �dce <br />SITE PHONE 0 with AREA CODE <br />t <br />r Ton <br />90'-6 <br />V <br />CITY G /- fS�TATE <br />��t�Cll ��v/ � <br />pZIPP CODE <br />QsvO <br />R of TANKS / <br />et SITE / <br />P <br />L <br />APPLICANT/BILLING AME <br />�i / ;�` <br />APPLICANT CONTACT NAME <br />�C <br />I <br />i <br />/ / %r "?a <br />C <br />A <br />MAILING ADD 55 <br />22 S L Toru Nd <br />APP iCANT PHOME R WITH AREA CODE <br />�;�-445(�'-/ <br />1 1988 <br />1 1989 <br />1990 1991 <br />T <br />CITY q <br />�J i�z <br />T 1E <br />P �^. <br />0.� <br />i PPLICATION <br />(Cloaur Installation, eta.) <br />TnTAi <br />A <br />C <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) • 5100.00 <br />1986 1987 <br />198E <br />1989 <br />1990 <br />t <br />T <br />I <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />K%%)! X%)0( <br />t <br />V <br />E <br />TANK FEE • %50.00/TANK (Prior to January 1,1991) 1170/TANK <br />(After <br />January <br />1, 1991) <br />F <br />A <br />C <br />X Tanks a <br />(multiply s by fee for <br />each year applicable) <br />1986 <br />1987 <br />1 1988 <br />1 1989 <br />1990 1991 <br />1992 <br />1993 <br />1994 <br />1995 1996 <br />t <br />ITANK <br />L <br />PENALTY FEES ASSESSED <br />10(1(% <br />XXX% <br />S <br />I <br />I <br />STATE SURCHARGE • 556.00 each TANK (Due every 5 years) See California H d S Code, Section 25287 <br />Y <br />R Tanks A 256.00 <br />(Enter ;Dant and year) <br />1986 through 1990 1991 through 1996 <br />t <br />C <br />L <br />PERMANENT CLOSURE (Reno"L or Authorized Closure -in -Place) TANK t.D. R(a) <br />0 <br />S <br />CLOSURE FEE • (78.00/hour (3 hours mfniaun/TANK) / TANK(s)__./__ K $234.00 <br />! 7 <br />U <br />R <br />TEMPORARY CLOSURE (Plan Review 6 Inspections) TANK I.D. 1(a) <br />E <br />TEMPORARY CLOSURE FEE • (78.00/hour (3 hours minimum/FACILITY) • (2X.00 minima <br />t <br />P <br />L <br />INSTALLATION PLAN CHECK (Plan Review d Construction Inspections) TANK I.D. R(a) <br />A <br />N <br />PLAN CHECK FEE • S78.00/hour (8 hours minIn.W FACILITY) * (624.00 minimum <br />t <br />R <br />E <br />REPAIR FEE (workplan Review 6 Cons true If on Inspections) <br />TANK I.D. /(a) <br />P <br />A <br />TANK LINING REPAIR FEE • 578.00/hour (3 hours mininun/TANK) <br />R TANK(&) % t234.00 = <br />f <br />I <br />R <br />TANK RETROFIT REPAIR FEE = t78.00/hour (3 hours min./FACILITY) • 9234.00 minimum <br />t <br />PIPING REPAIR FEE = 578.00/hour (3 hours minimum/ FACILITY) • $234.00 minimus <br />It <br />M TRANSFER FEE = 520.00 <br />t <br />S <br />C lCONSULTATION FEE 578.00/hr <br />FOR OFFICE USE ONLY <br />UNAUTHORIZED RELEASE EVALUATION • (78.00/hr <br />SAMPLING INSPECTION FEE • (78.00/hr <br />t <br />f <br />TOTAL DUE 5 - - <br />EH 23 032 (REVISED 3-1.93) Pace 11 <br />