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SAN JOAQUIN COU PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEAL IVSION <br /> UNOER—uROUND STORAGE TANK PROGRAM - FEE "rsHEET C1 3 <br /> S f C TY SITE NAME q fACll TY ACT NAME <br /> I <br /> CO S <br /> T <br /> E FACILITY ADORE ywA <br /> ITE PHONE / Nl th AREA CODE <br /> ' 7 f PClT /9 / AKS <br /> �TJE iIP CWE at SITEN of NP APPLLI�A1NT/ ILLING AME �"- APP ICANT,CONTACT NAME <br /> L Vas ( UI(OC . Er L <br /> 1 <br /> C MAILING ADDRESA APPLICANT PHONE If WITH AREA CODE <br /> A '. !(l( .f1C.1 r h'V i v D9 7S ?J Jf <br /> N <br /> T CITY ST�1T,� 21P,CODE � TION <br /> ��PosurE ofe Pinstatlation, etc.) <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1997) _ $100.00 <br /> A f <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) xxx% jxxxx I I I I f <br /> 1 <br /> V TANK FEE = S50.00/TANK (Prior to Janu*ry 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> N Tanks = 1986987 1988 1989 1990 1991 1992 191`3 1994 1995 1996 <br /> F (muttiply K by fee for <br /> A each year applicable) S <br /> C <br /> I TANK PENALTY FEES AS SE D XXXX XXXX S <br /> L <br /> I STATE SURCHARGE y�S56.00 each TANK (Due every 5 years) See California N d S Cade, Section 25287 <br /> T <br /> Y # Tanks z $56.00 1986 through 1990 1991 through 1996 <br /> (Enter unt and year) <br /> S <br /> - � <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. R(a) 5�J <br /> 0 CLOSURE FEE = S78.00/hour (3 hours minim n/JANK) R TANK(s) X $234.00 <br /> S <br /> U TEMPORARY CLOSURE (Plan Review d Inspections) TANK I.D. #(a) <br /> R <br /> E TEMPORARY CLOSURE FEE _ $78.00/hour (3 hours minimm/FACILITY) 5234.00 minimum f <br /> P INSTALLATION PLAN CH"tan Review d Construction Inspections) TANK I.D. R(s) <br /> L <br /> A ^ <br /> N PLAN CHEC E _ $78.00/hour (8 hours mininWFACILITY) = S624.00 mini Cell/S624.00 S <br /> R REPAIR FEE (Workplan Rev d Construction Inspections) TANK I.D. R iNCol JAjT' <br /> E _ <br /> P TANK LINING REPAI E _ $78.00/hour (3 hours minimum/TANK) A TANK(a) � CfH pIV„\' <br /> A <br /> I TANK RETROFI EPAIR FEE _ $78.00/hour (3 hours min./FACILITY) _ $234.00 minimus f <br /> R <br /> PIPING/R PAIR FEE = f78.00/hour (3 hours minimuVFACILITY) _ $234.00 mini mm f <br /> M TRANSFER FEE = EjO.'l70 UNAUTHORIZED RELEASE EVALUATION = E78.00/hr $ <br /> 1 <br /> S <br /> C CONSULTATI FEE _ $78.00/hr SAMPLING INSPECTION FEE _ $78.00/hr f <br /> TOTAL DUE E 7)C <br /> FOR OFFICE USE ONLY <br /> ............................................................................ . .......................................................................................................................................................................... <br /> »»w...»o.»a...»r.......»..u...»...».....e.»..»wei»»i:.».n.......nw w......a».......v.n.w..e...o..entry»n..n.....ne.w.......»»..».n..o...n»...n.»..»o..»u.n...»r.»r <br /> ON i VIRM It via” <br /> s <br /> a f " <br /> max �a�xasmxrax�mxccexxsmauaxs�x�xms'savmxspwrasrarxau��xr wrKrmirarnaiwxxas +�wxwn�a�aw:wawxaaxaoorwrsawunrrsirasaawsasrca�arwawA.•srw <br /> EN 23 032 fREVISED 3-1-93) Pace 11 <br />