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• SAN JOMIN r— 'M PUBLIC HEALTH SERVICES - ENVIROSIMMAL TN DIVSION <br /> STORAGE TANM K PROrR - FEE (A7Q MESW <br /> _ S FACILITY SITE NAME FACiLIT7 CONTACT NAME <br /> • E FACILITY ADDRESS <br /> M��E Illa(�-RA,�H <br /> K 1 6 $bs SITE PHONE # With AREA CODE <br /> A CITY STp e-k.To%1 STATE ZIP CODE # of TANKS <br /> P 5 a at SITE <br /> P APPLICANT/HILLHNG NAMEAPPLICANT CONTACT NAME n <br /> L Cs.'0 1 C eA T"NTc$ /✓G K)G, I]ILwSOn/ <br /> I <br /> C MAILING ADDRESS 2� O I �� APPLICANT PHONE # YITX AREA CODE <br /> T CITT �`� �� STATE ZIP ODE TT APPLICATION <br /> �/$3 5� osure, Installation, etc.) <br /> TOTAL <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 1986 1987 198 1990 <br /> C 8 1989=0( )0= XXXX S <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) )000( )000( XKKX S <br /> I <br /> V TANK FEE 550.00/TANK (Prior to Japery 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> # Tanks = 1986 1987 11988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F (multiply fee for <br /> A each year app icable) XXXX XXXX I )000: S <br /> C <br /> L TANK PENALTY FEES ASSESSED )O=XXXXX I XXXX S <br /> I STATE SURCHARGE = 556.00 each TANK (Due every 5 years) See California N A S Code, Section 25287 <br /> T <br /> T # Tanks z $56.00 I 1986 through 1990 1991 through 1996 <br /> (Enter arrant and year) <br /> S <br /> Cl PERMANENT CLOSURE 4VjMLvaDor Authorized Closure-in-Place) TANK I.D. #(s) 61 <br /> L <br /> D CLOSURE FEE = 178.00/hour (3 hours miniea/TANK) # TANK(s)__L__ X 5234.00 = 23y,6 T Z 3 O <br /> S <br /> U TEMPORARY CLOSURE (Plan Review L Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = 578.00/hour (3 hags minimmVFACILITY) 5234.00 minimum - S <br /> P INSTALLATION PUN CHECK (Plan Review S Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - 578.00/hour (8 hours miniam/FACILITY) = 5624.00 minimum S <br /> EI REPAIR FEE (Workplan Review A Construction Inspections) TANK I.D. #(s) <br /> P TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X 5234.00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) = 5234.00 minimum S <br /> R <br /> PIPING REPAIR FEE = 578.00/hour (3 hours mini=WFACILITY) = 5234.00 minimum S <br /> M TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION = 578.00/hr I S <br /> I <br /> S <br /> C CONSULTATION FEE = 578.00/hr SAMPLING INSPECTION FEE = 578.00/hr S <br /> TOTAL DUE S Z U <br /> _ER((�Efit�US�QM11r <br /> SWEEF 6OTEk ' "" `OOF�b OUNT�(-Ei:ETUSLaC'LTCJTSIiR � A cZt�CEFG€`6—s <br /> S <br /> EM 23 032 (REVISED 4-29-94) Page 11 <br />