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SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRCNMENTAL HEALTH DIVISION <br /> UNL�AOIND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> A CAREF'IT.T. HOMES, INC. TERRY HULL <br /> C <br /> 1 FACILITY ADDRESS SITE PHONE 0 with AREA CODE <br /> L 1700 S. EL DORADO <br /> I <br /> I CITY STATE ZIP CODE 0 of TANKS <br /> Y SA7CKTM CA 95206 at SITE 5 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P RAMLON MICHAEL S. RAMOS <br /> L <br /> 1 MAILING ADDRESS . APPLICANT PHONE 0 WITH AREA CODE t <br /> C 1401 HALYARD DRIVE, SUITE 130 (916) 372-7535 <br /> A <br /> I CITSTALE 21P5CCQE1 TYPE OF APPLICATION CLOSURE <br /> Y, SACRAMEN'T'O <br /> CA 99 6699 CLOSURE, INSTALLATION, etc. {t <br /> TOTAL <br /> A (t4 <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) - S100.00 I I f <br /> 1 1 E <br /> E TANK FEE • 550.00/TANK (prior to January 1,7991) 51 TO/TANK (after January 1, 1991) 4 <br /> F x Tanks a 5 19 1987 7988 1989 1990 1991 1992 1993 1996 1995 1996 <br /> A (multiply X by fee for 86 S <br /> C each year applicable) <br /> I <br /> L STATE SURCHARGE - $56.00 each TANK (Due every 5 years) Se! California N i S Code, Section 25287 <br /> 1 <br /> T 0 Tanks x 556.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount And year) 7 <br /> S <br /> _ 1 <br /> PERMANENT CLOSURE (Removal or Authorized Closure-In-Place) TANK I.D. #(s) <br /> C <br /> L CLOSURE FEE a $53.00 per hour (3 hours minimum per TANK) 0 TANK(s)_ x 5159.00 1 735.00 <br /> O <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/InspeeNfNd) TANK I.D. #(5) <br /> R � <br /> E TEMPORARY CLOSURE FEE a $150.00 each TANK 0 TANK(s) _ K 5150.00 S <br /> P PLAN CHECK (Install. Plan Review d Construction Inspections) TANK I.D. #(s) 06 L <br /> GL <br /> A <br /> N PLAN CHECK FEE - 553.00 per hour (8 hours mini" per Facility) - 1424.00 minimum S A <br /> R REPAIR FEE (workplan review 3 construction inspections) TANK I.D. #(5) <br /> E <br /> 0 TANK REPAIR FEE • $53.00 per hour (3 hours minimum/TANK) # TANK(s) K 5159.00 f <br /> A <br /> I <br /> R PIPING REPAIR FEE . S53.00 per hour (3 hour Afnifmm per facility - $159.00) S <br /> M TRANSFER FEE - 120.00 UNAUTHORIZED RELEASE EVALUATION - S53.00/hr S <br /> 1 <br /> 5 <br /> C CONSULTATIOI FEE - 553.00/hr SAMPLING INSPECTION FEE • 553.00/hr - S <br /> TOTAL DUE <br /> OFFICE USE ONLY <br /> E"ria�Pi5 :> <br /> ;::........".... <br /> i <br /> rur r.r a,w.r rrrr <br /> +1P'1lM 0alaaraPrrilrli YYY WT 1W161'1'dtl llf MSYI'Y lllaf fa NlJ W 9f 9SL 4P TMT YMfYif,/IJIRW fart i311901CpfiaMarriPllfAM laafaflY.Maai®!f! <br /> EH 23 032 fREv 4IE/011 It Pace 11 <br />