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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION (✓�� <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET 10 - <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> C UNITED PARCEL SERVICE <br /> 1 FACILITY ADDRESS SITE PHONE # with AREA COD <br /> L 1532 NO BROADWAY 800-222-833 <br /> 1 <br /> T CITY ST ZIP CODE # of TANKS <br /> Y STOCKTON, CA . �� At SITE 2 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P PETROLEUM ENGINEERING INC. HAROLD DYE <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> A <br /> H ST 707-545-9360 <br /> N CITY STATE ZIP CODE TYPE of APPLICATION <br /> T SANTA ROSA CA . 95401 CLOSURE, INSTALLATION, etc. INSTALLATI )N <br /> A TOTAL <br /> C 1986 1987 1988 1 1989 1 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 <br /> I = 170 . 00 <br /> E TANK FEE = 550.00/TANK (prior to January 1,1991) 5170/TANK Y(after January 1, 1991) <br /> F # Tanks 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (mdtiply X—by fee for <br /> C each year applicable) S <br /> 1 <br /> L STATE SURCHARGE = 556.00 each TANK (Due every 5 years) See California i S Code, Section 25287 <br /> I <br /> T # Tanksz 656.00 1986 through 1990 1991 through 1996 <br /> T (enter bnoiht and year) <br /> S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> CLOSURE FEE - $53.00 per hour (3 hours minimus per TANK) # TANK(s) ` X 5159.00 <br /> 230 .00 <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. #(s) <br /> R <br /> = TEMPORARY CLOSURE FEE = $150.00 each TANK # TANK(s) X 5150,00 = S <br /> { <br /> i <br /> P PLAN CHECK (Install. Plan Review S Construction Inspections) TANK I.D. #(s) i <br /> L <br /> A 424 . 00 <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minfa per Facility) 5424.00 minimm S <br /> R REPAIR FEE (workplan review d construction inspections) TANK I.D. #(s) <br /> E <br /> 7 TANK REPAIR FEE • $53.00 per hour (3 hours miniaxrVTANK) # TANK(s) X $159.00 5 <br /> 1 <br /> R PIPING REPAIR FEE • $53.00 per hour (3 hour minimus per facility = 5159.00) S () <br /> I CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> S <br /> C FEE-- 553.00/hr FEE = 253.00/hr FEE - $ 53..000f <br /> /hr <br /> TOTAL <br /> OFFICE USE ONLY ........ <br /> >✓Z YC'Jc� ` �..2 _:�i•Z__._ <br /> U <br /> .».�.��.��..�.�.���.......�—..��.•...,..��.,...�.•.��.,....��rpr�:Sr.__....__.�....»'.tea.._ _ �._»»»» __.._........ <br /> i+s;�S�s'- C�P�T ':• �O�C e i)�1 C ) i I C,�f7� �n�ec ju.{ I~`"` tCaai/ Je F"eY '•�'�lei�i �aAl <br /> ri��r•r�.0 ». <br /> Y•i�a��aili�iaWiill-Iiall/iiilli/��IifAl�il•�Iliiw av a,r�Yillri�l�-a,Y r. �.J I•��i11aYa%M•l il�1011�ri•�lii <br /> EN 23 02 (REV 1/10/911 ft Pace 11 <br />