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Piping Only <br />SAN JOAQUIN CA PUBLIC HEALTH SERVICES - ENVIRONMENTAL HE DIVSION <br />UNda..aRQAm STORAGE TANK PROGRAM - FEE WORKSHEET`/ <br />S <br />FACILITY SITE NAME <br />1986 <br />FACILITY CONTACT NAME <br />I <br />ARQD Facility 5569 <br />1990 <br />Presticre Stations Inc. 5289 <br />T <br />E <br />FACILITY ADDRESS <br />SITE PHONE # with AREA CODE <br />TEMPORARY CLOSURE (Plan Review & Inspections) <br />3518 E. Hammer Lane <br />(2 09 474- 43 <br />a <br />CITY <br />STATE ZIP .CODE # of TANKS <br />A <br />Stockton <br />CA 95210 at SITE 3 <br />P <br />P <br />APPLICANT/BILLING MANE <br />5 <br />APPLICANT CONTACT NAME <br />L <br />Tait & Associates <br />XXXX <br />I XXXX <br />I <br />C <br />MAILING ADDRESS <br />APPLICANT PHONE N WITH AREA CODE <br />A <br />1001 GalaxyWa Ste. 404 <br />$170/TANK (After January 1, 1991) <br />1 -6800 <br />T <br />CITY <br />STATE <br />ZIP CODE <br />TYPE of APPLICATION <br />1989 <br />1990 <br />1991 <br />9 20 <br />(closure. Installation, eta.) <br />1994 <br />IAn(brfl <br />1996 <br />F <br />TOTAL <br />C <br />PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) <br />1986 <br />1987 <br />1988 <br />1989 <br />1990 <br />S <br />S 624.00 <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) _ $100.00 <br />U <br />TEMPORARY CLOSURE (Plan Review & Inspections) <br />TANK I.D. #(s) <br />R <br />E <br />TEMPORARY CLOSURE FEE = $78.00/hour (3 hours minimum/FACILITY) <br />5234.00 minimum <br />A <br />R <br />XXXX <br />XXX% <br />PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) = 9234.00 minimum <br />5 <br />S <br />C <br />T <br />FACILITY PENALTY FEES ASSESSED (if Applicable) <br />XXXX <br />I XXXX <br />S <br />I <br />V <br />TANK FEE • f50.00/TANK (Prior to January 1,1991) <br />$170/TANK (After January 1, 1991) <br />E <br />A Tanks • <br />1986 <br />1987 <br />1988 <br />1989 <br />1990 <br />1991 <br />1992 <br />1993 <br />1994 <br />1995 <br />1996 <br />F <br />(multiply # by feefor <br />A <br />each year applicable) <br />XXXX <br />XXXX <br />f <br />C <br />I <br />TANK PENALTY FEES ASSESSED <br />XXXX <br />%XXX <br />f <br />L <br />I <br />STATE SURCHARGE _ 156.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 <br />T <br />T <br /># Tanks z S56.001988 <br />through 1990 <br />1991 through 1996 <br />(Enter amount and year) <br />f <br />C <br />PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) <br />TANK I.D. #(s) <br />L <br />0 <br />CLOSURE FEE - $78.00/hour (3 hours minimum/TANK) <br /># TANK(s)_ X 5234.00 = <br />S 234.00 <br />S <br />S 624.00 <br /># TANK(s) X 5234.00 = <br />U <br />TEMPORARY CLOSURE (Plan Review & Inspections) <br />TANK I.D. #(s) <br />R <br />E <br />TEMPORARY CLOSURE FEE = $78.00/hour (3 hours minimum/FACILITY) <br />5234.00 minimum <br />S <br />P <br />INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) <br />FTANK I.D. #(s) <br />L <br />::,:.:—•- <br />_ - _ <br />= Y SWEEPS # <br />A <br />N <br />PLAN CHECK FEE = $78.00/hour (8 hours minimum/FACILITY) = $624.00 minimum <br />S 624.00 <br />R <br />REPAIR FEE (Workplan Review & Construction Inspections) <br />TANK I.D. #(s) <br />E <br />::,:.:—•- <br />_ - _ <br />= Y SWEEPS # <br />S <br />C <br />P <br />TANK LINING REPAIR FEE = 978.00/hour (3 hours minimum/TANK) <br /># TANK(s) X 5234.00 = <br />S <br />A <br />I <br />TANK RETROFIT REPAIR FEE - 978.00/hour (3 hours min./FACILITY) = $234.00 minimum <br />S <br />R <br />PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) = 9234.00 minimum <br />5 <br />N <br />TRANSFER FEE - S20.00 UNAUTHORIZED RELEASE EVALUATION = S78.00/hr <br />S <br />I <br />::,:.:—•- <br />_ - _ <br />= Y SWEEPS # <br />S <br />C <br />CONSULTATION FEE = $78.00/hr SAMPLING INSPECTION FEE = $78.00/hr <br />5 <br />TOTAL DUE <br />S858.00 <br />FOR OFFICE USE ONLY <br />EN 23 032 (REVISED 10-28-93) i� �� <br />....._ <br />.. .. ..... .... <br />.c:a <br />::,:.:—•- <br />_ - _ <br />= Y SWEEPS # <br />COMPUTER # <br />LOC CODE DIST CODE <br />AMOUNT RECEIVED <br />CHECK #/CASH RECEIVED 8Y I DATE RECEIVED 3 <br />EN 23 032 (REVISED 10-28-93) i� �� <br />