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SAN JOAQUIN COmWY PUBLIC REALTN SERVICES - ENVIROMENTAL %N dll DIVSIOII <br /> UNDERGROUND STORAGE TANK PROfFM - FEE WORKSNIEET <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> I D <br /> I <br /> E FACILITY ADDRESS SITE PHONE M with AREA CODE <br /> 25474 Hwy. 4, Farmington, CA 95230 (209) 886-5328 <br /> A <br /> CITY STATE ZIP CODE R of TANKS <br /> A at SITE 2 <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L Paydirt Excavating Co. INc. Lou Tvedt <br /> I -*- <br /> C MAILING ADDRESS APPLICANT PHONE R WITH AREA CODE <br /> A 269 Oregon St. (209) 599-2347 <br /> R <br /> t CITY STATE ZIP CODE TYPE of APPLICATION <br /> Ripon CA 95366 (Closure, InatsUetlan, ete.IClosure <br /> TOTAL <br /> 1986 1987 1968 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 <br /> A XXXX XXXX S <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) %XXX %%XN 5 <br /> 1 <br /> V TANK FEE 550.00/TANK (Prior to January 1,1991) 5170/TANK (After January i, 1991) <br /> E <br /> s Tanks = _ 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F (multiply R by fee for <br /> A each year applicable) XXXX XXKK S <br /> C <br /> 1 TANK PENALTY FEES ASSESSED XXXX XXXX 5 <br /> L <br /> I STATE SURCHARGE • $56.00 each TANK (Due every 5 years) See California H 5 S Code, Section 25287 <br /> T <br /> Y f Tonka a $56.00 1988 through 1990 1991 through 1996 <br /> nd <br /> (Enter rmnt aynr) <br /> 5 <br /> C PERMANENT CLOSURE (Removat or Authorized Closure-ln-Place) TTANK I.D. R(a) <br /> L <br /> 0 CLOSURE FEE • S78.00/hour (3 hours minissaA/TANK) NK(s) 2 X 5234.00 = S 468.00 <br /> SU TEMPORARY CLOSURE (Pian Review L Impactions) I.D. R(s) <br /> R <br /> E TEMPORARY CLOSURE FEE • S78.00/hour (3 hours minfoum/TANK) / TANK(s)_ X $234.00 ! <br /> P INSTALLATION PLAN CHECK (Plan Review A Construction InsPectforo)I TANK I.D. #(a) <br /> — <br /> L <br /> A <br /> N PLAN CHECK FEE • 578.00/hour (8 hours mfnIauWFACILITY) S624.00 minimum 5 <br /> R REPAIR FEE (Workplan Review 5 Construction Inspections) 71 TANK I.D. M(a) <br /> E <br /> P TANK LINING REPAIR FEE • 578.00/hour (3 hours miniaaas/TANK) / TANK(s) X $234.00 • 5 <br /> A <br /> 1 TANK RETROFIT REPAIR FEE • 578.00/hour (3 hours min./FACILITY) • 5234.00 minimum S <br /> R <br /> PIPING REPAIR FEE • 178.00/hour (3 hours minimus/!AGILITY) 5234.00 minimum 5 <br /> M TRANSFER FEE • S20.00 UNAUTHORIZED RELEASE EVALUATION • 578.00/hr S <br /> 1 <br /> 5 <br /> [I CONSULTATION FEE 578.00/hr SAMPLING INSPECTION FEE • 578.00/hr S <br /> TOTAL DUE S <br /> FOR OFFICE 115E ONLY <br /> ,.... '!t '1. . :;�,!,:-n,:::,m!,,,,,.f^^' Tm�mm,m,mnm,mr,^�^-^'^I <br /> MiNNNNumal <br /> SWEEPS It COMPUTER R LOC CODE DIST CODE AMOUNT RECEIVED CHECK R/CASH RECEIVED BY DATE RECEIVED <br /> _ e <br /> ................................................................................................... <br /> ........................ ................................. ......................... ........... ........._..........._.:... v:ununc:c::mm:: nn :;:n-m:ra:r.::-!:y:: :;:::vr,:'iii!!f!!!iili2'.!!L•!i!i!!8a+.n!!c^°R91!'HL'niirian!a <br /> :x:::icv- n::m!:xum?!Ills!iMi,a!::::n:Li!::::::a!!Jur:nin22R::r_u!::n:n!nnm__....:rJr.:3a.........._..._........Id....i..l.11..d..i L.....: <br /> EN 23 032 (REVISED 6-21.93) Page 11 <br />