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ICES - <br /> NVIRONMENTAL <br /> SAN JOAW[N ! HEALTH STORAGETANKVPROGRAME- FEE YORKSHEEI' 01 ^ W <br /> FACILITY CONTACT NAME <br /> S FACILITY SITE NAME <br /> ell <br /> I Trac Hi chool - Old Trans . De Ms . Ann B <br /> T SITE PHONE # with AREA CODE <br /> E FACILITY ADDRESS ( 209 ) 831-5032 <br /> 315 E. 11th Street <br /> L STATE ZIP CODE # of TANKS <br /> CITY <br /> CA 95376 at SITE' 1 <br /> A Tracy _ _ — --- — <br /> 1' -- - APPLICANT CONTACT NAME. <br /> P APPLICANT/OILLING NAME Anne Bell. <br /> L <br /> I APPLICANT PHONE # WITH AREA CODE <br /> C MAILING ADDRESS <br /> A 315 E . 11th Street ( 209 ) 831-5032 <br /> N STATE ZIP CODE TYPE of APPLICATION <br /> T CITY (closure, )FPF*a'�Yro)rbVvX&Z(.>5 <br /> Tracy CA 95376 <br /> TOTAL <br /> 1986 11987 1988 1989 1990 <br /> ANNUAL dCILITY FEE (Prior to January 1, 1991) _ $100.00 S <br /> . A <br /> [ 5 <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) X%XX X%XX <br /> VI TANK FEE _ %50.00/TANK (Prior to January 1,1991) <br /> 5170/TANK (After January 1, 1991) <br /> 9 Tanks = 1986 11987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F (multiply R byby fee for I 5 <br /> A each year applicable) <br /> C 5 <br /> I TANK PENALTY FEES ASSESSED XXXX xxxx <br /> Ll <br /> 1 STATE SURCHARGE - $56.00 each TANK (Due every 5 years) See California H 8 5 Code, Section 2528 — <br /> T1941 th rau0h 1996 <br /> YI # Tanks _ x 556.00 1986 through 1990 __ _ <br /> (Enter amount and year) S <br /> CI PERMANENT CLOSURE (Removal or Authorized C(osure•in-Place) TANK I.D. #(s) <br /> L <br /> 0 CLOSURE FEE - $78.00/hour (3 hours minimm/TANK) # TANK(s)_ % 2234-00 2-34� -0C) <br /> ,S <br /> U TEMPORARY CLOSURE (Plan Review 8 Inspections) TANK I.D. <br /> R - �V1✓ <br /> E TEMPORARY CLOSURE FEE = 578.00/hour (3 hours minimxm/TANK) # TANK(s) % $234.00 - S —0— <br /> PI INSTALLATION PLAN CHECK (Plan Review 8 Construction Inspections) TANK I.D. #(s) <br /> L <br /> AAm <br /> q <br /> Ml xm <br /> PLAN CHECK FEE _ $78.00/hour (8 hours mini 5624.00 mini n <br /> R REPAIR FEE (Workplan Review 8 Construction Inspections) TANK I.D. #(s) <br /> E 5 <br /> P TANK LINING REPAIR FEE = $78.00/hour (3 hours minimum/TANK) # TANK(s) _ X $234.00 = —0- <br /> A <br /> I TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min-/FACILITY) - 5234.00 minimum $ —0— <br /> R <br /> PIPING REPAIR FEE = $70.00/hour (3 hours mininun/FACILITY) • 52 :.00 minimum % <br /> NJ TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION = 578.00/hr S __0_ <br /> II — <br /> S 5 <br /> L CONSULTATION FEE = -_78.0 hr SAMPLING INSPECTION FEE = 578.00/hr <br /> TOTAL DUE 5 <br /> FOR OFFICE USE ONLY .. _ ,_ <br /> SWE_Pa # CONFUTER # LOC CODE DIST CODE AMOUNT RECEIVED CHECK #/CASH RECEIVED BY GATE RECEIVED <br /> EA 23 032 (REVISED 11-1.92) Page 11 <br />