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SAN JOAOU)k NTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL` STH DIVSION <br />UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHECT' <br />S <br />FACILITY SITE NAME <br />FACILITY CONTACT NAME <br />I <br />Martini Au <br />Bill Little 467-1006 <br />T <br />E <br />FACILITY ADDRESS <br />SITE PHONE # with AREA CODE <br />A <br />I <br />4032 N E1 Dorado Street <br />209 462-8696 <br />& <br />CITY Stockton <br />STdATE <br />C <br />CppE <br />�P5 LU / <br />one <br />A <br />at SITE <br />P <br />P <br />APPLICANT/BILLING NAME <br />APPLICANT CONTACT NAME <br />L <br />X%X% <br />X%XX <br />I <br />C <br />MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />%X%%KXXX <br />5457 Covey Creek Circel <br />209 473-0501 <br />A <br />N <br />T <br />CITY Stockton <br />ca TE <br />2I 000E <br />yPSLU/ TYPE of APPLICATION <br />T <br />(Closure, Installation, GLC.) <br />P <br />INSTALLATION PLAN CHECK (PLan Review & Construction Inspections) <br />TANK I.D. #(s) <br />L <br />1986 <br />1987 <br />1988 <br />1989 <br />1990 <br />A <br />I <br />TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) <br />= $234.00 minimum $ <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br />PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) <br />= 5234.00 minimum 5 <br />XXXX <br />X%X% <br />X%XX <br />X%XX <br />XXXX <br />$ <br />%X%%KXXX <br />A <br />T <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />%%XX <br />XXXX <br />X%%X <br />%XXX <br />XXXX <br />S <br />X%%%XXXX <br />I <br />V <br />TANK FEE = 550.00/TANK <br />(Prior to January 1,1991) <br />5170/TANK (After <br />January 1, 1991) <br />E <br /># Tanks= <br />1987 <br />1988 <br />1989 <br />1990 <br />1991 <br />1992 <br />1993 <br />199/. <br />1995 <br />1946 <br />1997 <br />F <br />(multiply # by fee for <br />%XXX <br />XXXX <br />%XXX <br />��4l7 <br />�0 <br />ff r1 <br />I ( r7 <br />1 k-%0 <br />/0zo <br />A <br />each year applicable) <br />XXXX <br />XXX% <br />\ 1 <br />C <br />I <br />TANK PENALTY FEES ASSESSED <br />XX%% <br />X%XX <br />%XXX <br />XX%% <br />XXXX <br />1 <br />(� <br />D <br />(� <br />L7 <br />J <br />L'S <br />I <br />STATE SURCHARGE FOR NEW FACILITIES <br />ONLY = $18.50 <br />T <br />Y <br /># Tanks x 58.00 <br />1988 through 1990 ($561 <br />1991 through <br />1996 <br />(S56) <br />1 <br />%XXXX%%%%XXXX%XXX%XXXX%XXX% <br />XXXXXXXXXXXXXXXXXX%X%%% <br />S <br />SURCHARGE FOR 1997 <br />C <br />PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) <br />TANK I.D. #(s) <br />0 <br />CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) <br /># TANK(s)X <br />5234.00 = <br />5 <br />2 3q ama <br />S <br />U <br />TEMPORARY CLOSURE (Plan Review & Inspections) <br />TANK I.D. #(a)— <br />R <br />E <br />/FACILITY) <br />TEMPORARY CLOSURE FEE - S78.00/hour (3 hours minimum/FACILITY) <br />5234.00 minimum <br />$ <br />P <br />INSTALLATION PLAN CHECK (PLan Review & Construction Inspections) <br />TANK I.D. #(s) <br />L <br />A <br />N <br />PLAN CHECK FEE = S78. 00/hour (8 hours minimNFACILtTY) = $624.00 minimum <br />$ <br />R <br />REPAIR FEE (Workplan Review & Construction Inspections) <br />TANK I.D. #(s)— <br />E <br />P <br />TANK LINING REPAIR FEE = 578.00/hour (3 hours mini=m/TANK) <br /># TANK(s) X $234.00 = S <br />A <br />I <br />TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) <br />= $234.00 minimum $ <br />R <br />PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) <br />= 5234.00 minimum 5 <br />N TRANSFER FEE = $20.00 <br />I <br />5 <br />CONSULTATION FEE = S78.00/hr <br />FOR OFFICE <br />SWEEPS <br />EH 23 032 (REVISED 5-27-97) <br />UNAUTHORIZED RELEASE EVALUATION = 578.00/hr <br />SAMPLING INSPECTION FEE <br />CODE I DI <br />S <br />= 578.00/hr <br />CHECK <br />22�a� <br />S <br />S <br />$ <br />DATE RECEIVED <br />