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SAN JOAQUIN CL—Y PUBLIC HEALTH SERVICES - ENVIRONMENTAL Hb4H DIVSION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> I PIEDMONT LUMBER & MILL CO. INC. EDWARD SMITH CFO <br /> T <br /> E FAr.71117 9DAF�SsELEVENTH STREET SITE PHONE # with AREA CODE <br /> i //// <br /> NQNF <br /> CITY -TRACY STATE ZIP CODE # of TANKS <br /> P CA 95376 at SITE ONE <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L <br /> 1 <br /> C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> A 395 TAYLOR BLVD., SUITE 225 I 48770 <br /> N <br /> T CITY PLEASANT HILL SWE Z P CODE TYPE of APPLICATION <br /> l.A 94523 (Closure, Installation, etc.) CLOSURE <br /> TOTAL <br /> 987 1986 <br /> ANNUAL FACILITY FEE (Prior to January i, 1991) = 4100.00 1986 11989 1 1990 <br /> A XXXX XXXX XXXX S <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XXXX xxxx f <br /> 1 <br /> E TANK FEE = 450.00/TANK (Prior to January 1,1991) $170 TANK (After January 1, 1991) <br /> # Tanks = 1986 1987 1988 1989 1990 1997 1992 1993 1994 1995 1996 <br /> F (multiply #Tv fee for <br /> A each year applicable) XXXX xxxx xxxx 4 <br /> C <br /> I TANK PENALTY FEES ASSESSED I XXXX XXXX XXXX f <br /> L <br /> I STATE SURCHARGE = S56.00 each TANK (Due every 5 years) See California H i S Code, Section 25287 <br /> T <br /> Y # Tanks x 556.00 1986 through 1990 1991 through 1996 <br /> (Enter Fm—t and year) <br /> S <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> L <br /> 5 CLOSURE FEE = 478.00/hour (3 hours minimum/TANK) # TANK(s)ONE X 5234.00 = $234.00 <br /> U TEMPORARY CLOSURE (Plan Review i Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE - S78.00/hour (3 hours minimum/FACILITY) $234.00 minimum 4 <br /> P INSTALLATION PLAN CHECK (Plan Review 8 Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = 478.00/hour (8 hours minimuNFACILITY) _ $624.00 minimum 4 <br /> R REPAIR FEE (Workplan Review i Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE = $78.00/hour (3 hours minimum/TANK) # TANK(s) _ X $234.00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE = 478.00/hour (3 hours min./FACILITY) = $234.00 minimum S <br /> R <br /> PIPING REPAIR FEE = 578.00/hour (3 hours mininuNFALILITY) _ $234.00 minimum E <br /> M TRANSFER FEE = $20.00 UNAUTHORIZED RELEASE EVALUATION = $78.00/hr S <br /> I <br /> S <br /> C CONSULTATION FEE = f78.00/hr SAMPLING INSPECTION FEE = 578.00/hr 4 <br /> TOTAL DUE s 234.00 <br /> F.Q.H.._P_F.F.I.4.E._!!.s._O..HLT.__.__ .._..__._. ..._._._.—__.._..._.__ --_-:,-:_- <br /> _............::.....:.....:.:............._._...............,:,-: :e:::_-:-_-.-. — :::.—..-:e.. .:....::::_.........._........_...__.........:: _....._a........:........................:.__...._.._._.........._........._ <br /> _.__....._................._........,..._...._....... .._........................................................... ..... ......_...... .... <br /> 4WEED4 # LOMPUTEk # LbC CGDE DIsT CODE AMOUNT RECEIVED CHECr#7CASR RECECvEO BT DATE 99C w <br /> _.._...._...._........_........__...._......_...._..........__...._.._..........v_...._...._._.._.h........._.......:..............................................................4..........:...................T.II...................................::::n:::::::-::::. F.::....... <br /> ..u:...... .:............................. <br /> : ...................... .............:::::.:.:::::.::..........:.......a::::c:::::c:....::::::::, <br /> EH 23 032 (REVISED 4-29-94) Page TWO <br />