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7 <br /> / <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> F FACILITY SITE NAME FACILITY CONTACT NAME <br /> C <br /> 1 FACILITY ADDRESS SITE PHME ! with AREA CODE <br /> L 20 �t1 <br /> T Cl T, STATE 2IP CODE i of TANKS <br /> Y Ca- st SITE <br /> A APPL CANT/B LLINO NAME APPLICANT CONTACT NAME <br /> P _ <br /> P <br /> L r k ? - CJ A(' �. <br /> AL`>I NC ADDRESS 'moo OAP PHONE ! WITH AREA CODE <br /> T DIT STATEI ZIP CODE TYPE of APPLICATION <br /> CLOSURE, INSTALLATION, etc. <br /> A TOTAL <br /> 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) $100.00 <br /> 1 S <br /> V <br /> E TANK FEE 550.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F N Tanks I Ives tvay Ivetl Tvev Ivv0 te77 tvv 1 199A 1995 1996 <br /> A (multiply V-Tfes for <br /> C each year appll lesble) 5 <br /> 1 <br /> STATE 8URCHARGE • 556.00 each TANK (Due every 5 years) See Calffornia N d S Code, Section 25287 <br /> T ! Tanks x 556.00 1986 through 1990 1991 through 1996 <br /> Y (enter EMt and year) <br /> S <br /> C <br /> PERMANENT CLOSURE (Removal or Authortted Closure•In-Place) <br /> Ol CLOSURE FEE • 253.00 per hour (3 hours minimus per TANK) ! tANK(e) X $159.00 • S <br /> S <br /> U TEMPORARY CLOSURE_(A one-time permit, for review/Inspections) TANK I.D. !(a) <br /> R <br /> E TEMPORARY CLOSURE FEE • $150.00 each TANK I IT TANK(s) X 5150,00 S <br /> P PLAN CHECK (Install. Plan Review 5 Construction Inspections) I TANK I.D. !(s) <br /> LlA <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minims per Faeility) = 5424.00 minfmum S <br /> R REPAIR FEE (workplan review L construction inspections) TANK I.D. !(s) <br /> E <br /> P TANK REPAIR FEE = 553.00 per hour (3 hours mininmVTANK) ! TANK(a) x $159.00 S <br /> A <br /> 1 <br /> R PIPING REPAIR FEE • $53.00 per hour (3 hour minimper facility • $159.00) 5 7S' J <br /> minimum <br /> M <br /> TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION 553.00/hr 5 --� <br /> 5 <br /> ClCONSULTATION FEE = 553.00/hr SAMPLING INSPECTION FEE • 553.00/Ar S <br /> TOTAL DUE S <br /> OFFICE 1.10 <br /> Mrw ia�usuuunc;�xnmawuv!rs!+.L�.'umiwmro�r.Wa—„u <br /> EH 23 032 (Revised 4/8/91) Page 11 _L C,— <br />