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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVSION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> SI FACILITY SITE NAME I FACILITY CONTACT NAME <br /> I Gateway Project Ron Palmquist <br /> T <br /> E FACILITY ADDRESS .rYh4- SITE PHONE # With AREA CODE <br /> R1 ck b nde y Lai`•ayette, E� Dora o, <br /> e <br /> Center and Sonor 209-937-8320 <br /> C:7Y Stockton STATE ZIP CODE # of TANKS <br /> A CA 95202 at SITE <br /> P. <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> Evans Brothers Inc. John Crawford <br /> L <br /> 1 <br /> L MAILING ADDRESS 7589 National Drive APPLICANT PHONE # URN AREA CODE 925-443-0225 <br /> A <br /> N <br /> T CITYi STATE ZIP CODE TYPE of APPLICATION <br /> Livermore I CA 94550 (Closure Installation, er_.) <br /> TOTAL <br /> 1986 11987 11988 1 1989 11990 ' <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 <br /> A XXXX XXX% KXXX %XXX I XXX% S XXXX%XXX <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (It Applicable) i %XXX %XXX I XXXX XXXX I XXXX S %XXXXXX% <br /> 1 <br /> V TANK FEE = S50.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> 4 Tanks = i 11988 1989 11990 1991 1992 I�K 1 1994 11995 1 1996 1 1997 11 ✓C <br /> F (.muLtipLy # by tee for <br /> A each year app(icable) 1 XXX% %XXX XXX1L %XXX I%XXX 11 1/ 1 1 .70 /701 /7UI /713 )7U 1 171 S <br /> C J <br /> II TANK PENALTY FEES ASSESSED XXXX X%%X <br /> L I XXXX I x%XX (XXXX I 701 X701 7U 1 00 170/7N S /L) <br /> y <br /> 1 STATE SURCHARGE FOR NEW FACILITIES ONLY-S18.50 <br /> T <br /> Y # Tankss 38.00 I 1988 through 1993 (556) 1993 through 1997 (S56) 199cl ? D(9�9 ' <br /> SURCHARGE FOR 1998 XXX%XXXXXXXXXXXXX%XXX%XXX%% XXXXX%XXXXXXXXX%%%%XXXX <br /> C PERMANENT CLOSURE (Removal 01 AWehpriZeb Closure-in-PLace) TANK I.D. #(s) Unknown <br /> L <br /> 0 C�OSURE FEE = 578.00/hour (3 hours minimum/TANK) Y TANK[$) 1 X 5234.00 = ( s 234.00 <br /> S <br /> U TEMPORARY CLOSURE (PLan Review L Inspections) TANK 1.9. #(s) <br /> R <br /> EI TEMPORARY CLOSURE FEE - S78.00/hour (3 hours minimum/FACILITY) S234.00 minimum S <br /> P [NSTALLATI ON PLAN CHECK (P Lan Review 8 Construction Inspections)I TANK I.O. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = S78.00/hour (8 hours minim WFACILITY) s 5624.00 mini mm S <br /> R REPAIR FEE (Workplan Review L Construction Inspections) TANK I.O. #(s) <br /> E <br /> P TANK LINING REPAIR FEE - S78.00/hour (3 hours minimum/TANK) # TANK(s) X 5234.00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = 5234.00 minimum S <br /> R <br /> PIPING REPAIR FEE = S78.00/hour (3 hours minim m/FACILITY) = S234.00 minimum S <br /> i N TRANSFER FEE = S20.00 i I UNAUTHORIZED RELEASE EVALUATION - S78.00/hr I I I S <br /> I <br /> SI I 1 <br /> C CONSULTATION FEE = S78.00/hr I SAMPLING INSPECTION FEE - S78.00/hr I I S <br /> TOTAL DUE S 2 .00 <br /> FOR OFFICE USE ONLY 7 �/� 'Z -3 j <br /> .w mmm!!: :i�xaumn nnm•�:sses. Orr — awmm:m _ - �t(se!Am _ �,•� <br /> -um�euuumimm!m!¢mmdmmmW u - <br /> SWEEPS # COMPUTeR # LOC CODE I� DIST CODE I AMOUNT 0.ECE! p CHECK #/GSH I RECEIVED BY DATE RECEIVED <br /> uu r m.O <br /> IVI�Yi.!i0eiuimmmimmliviuW '1uiu4u01'JPl�wfLly�A3'sv+ 'j0e!J!n8ylnvwr-"a"'Y�Vy!L91.a_,".Ny'L'Y!"L"�v �Tv�,'�i�+v®n � '�em'''W",fiI''�*d5nv, r "op <br /> =W PX .112 [RFV)SFD 1.12.98) SNUG I � � p^�L.(/���-�m,,�(•��l N^�T dpe(,gh"N•"/��`^"' <br />