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SAN JOA09IM DNISE�TXSERVICES - PROGRAM LTH DYION <br />IBTORAGETANK - FEE WORKSHEET <br />FACILITY SATE NAME / FACILITY CONTACT 'ROME I NES/� <br />FACIbITY ADDRESS —11 SITE PHONE # with AREA (EOE nn� <br />CITY ( TE ZIP CODE at of SITEN 1 (� <br />CLING APPLICANT CONTACT NAME <br />APPLICANT/ I yIAy <br />MAILING ADDRESS` APPLICANT PHONE # WIT)L„AREA `J[ <br />CITY T TE Jrt� TYPE of APPLI APPLICATION Q <br />"( (Closure, Installation, etc.) Clcs(_1.� <br />TOTAL <br />EH 23 032 (REVISED 4-29-94) Page 11 <br />l <br />1986 1987 11988 1989 11990 <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br />XXXX XXXX X700( <br />o� <br />A <br />C <br />FACILITY PENALTY FEES ASSESSED CIf Applicable) <br />xxxxS <br />XXX% / Ov <br />r oD <br />T <br />1 <br />V <br />TANK FEE = 550.00/TANK (Prior to January 1,1991) <br />anus <br />5770/TANK (After January 1, 1 1) <br />(After <br />E <br /># Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 119% <br />A <br />a—oY� <br />eachtyear applic ble)r X)O(X XXXX I xxxx �,V <br />.. I <br />5 �w <br />I <br />TANK PENALTY FEES ASSESSED1 XXXX I X)O(X I XXXX 1 7 <br />L <br />I <br />STATE SURCHARGE = 556.00 each TANK (Due every 5 years) See California X 8 S Code, See -ion 2528 <br />T1986 <br />Y <br /># Tanks_ x 556.00 through 1990 <br />1991 through 1996 <br />(Enter amount and year) ;;� <br />5 117— <br />CLOSURE (Removal or Authorized Closure -in -Place) I <br />TANK I.D. #(s)— <br />C <br />L <br />0 <br />PERMANENT <br />CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) <br /># TANK(5)� X s234.00 = <br />s <br />S-. <br />U <br />TEMPORARY CLOSURE (Plan Review i Inspections) <br />TANK I.D. #(s) <br />R5 <br />E <br />TEMPORARY CLOSURE FEE = x78.00/hour (3 hours minimum/FACILITY) <br />5234.00 minimum <br />8 Construction ImPections)I <br />TANK I.D. #(s) <br />P <br />INSTALLATION PLAN CHECK (Plan Review <br />L <br />A <br />M <br />PLAN (NECK FEE = 578.00/hour (8 hours minioun/FACILITY) <br />= $624.00 minimum <br />s <br />REPAIR FEE (Workplan Review 8 Construction Inspections) <br />TANK I.D. #Cs) <br />R <br />P <br />FEE = 578.00/hour (3 hours minimum/TANK) <br /># TANK(s) _� X 5234.00 = <br />S <br />TANK LINING REPAIR <br />S <br />A <br />REPAIR FEE = S78.00/hour (3 hours min./FACILITT) <br />a 5234.00 minimus <br />I <br />TANK RETROFIT <br />I s <br />R <br />PIPING REPAIR FEE - S78.00/hour (3 hours minimum/FACILITY) <br />= 5234.00 minimum <br />M <br />TRANSFER FEE 520.00 I UNAUTHORIZED RELEASE EVALUATION - S78.00/hr I I <br />5 <br />( <br />S <br />C <br />CONSULTATION FEE = 578.00/hr SAMPLING INSPECTION FEE <br />- 578.00/hr <br />s <br />TOTAL DUE <br />s <br />EH 23 032 (REVISED 4-29-94) Page 11 <br />