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FfffJ_J SAN JOAGUIN COUNTY PUBLIC HEALTH SERVICES <br /> ' <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE 4CRKSHEET <br /> F FACILITY SITE NAME FACILITY CONTACT NAME <br /> A Sierra Bay Farm Credit Service <br /> C Eliot Appleton <br /> I F CI ITV ADDRESS SITE PHONE / with AREA CODE <br /> L Burns-Cutoff Road N/A <br /> I <br /> Wockton, STATE ZIP CODE ! of TANKS <br /> CA at SITE 1 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> Sierra Bay Farm Credit Service <br /> i t Eliot Appleton <br /> I "AILING ADDRESS APPLICANT PHONE I WITH AREA CODE <br /> C P. 0. Box 8070 (209 931-3770 <br /> A <br /> Y N CITY STATE ZIP CODE TYPE of APPLICATION <br /> I Stockton CLOSURE, INSTALLATION etc. <br /> CA Removal <br /> A Ag tank - Exempt from back fees per DougWilson TOTAL <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) • $100.00 <br /> I <br /> V f <br /> E FANK FEE a 150.00/TANK (prior to January 1,f9191) $170/TANK (after January 1, 1991) <br /> F I Yanks 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multipty fee for <br /> C each year applicebte) <br /> I S <br /> l STATE SURCHARGE • $56.00 each TANK (Due every 5 years) $ea Call(ornia H $ S Code, Section 25287 <br /> x, T R Yanks n $56.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) <br /> f <br /> PERMANENT CLOSURE (Removal or Authorized Closure-lm Place) <br /> C TANK I.D. I(s) <br /> L CLOSURE FEE m $53.00 per hour (3 hours minimum per TANK) I TANK(s) 1 <br /> 0 x $159.00 f 159.00 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. I(a) <br /> R <br /> E TEMPORARY CLOSURE FEE • S150.00 each TANK IT TANK(s) x $150.00 <br /> f <br /> P PLAN CHECK (Iretall. Plan Review t Construction impectlons) TANK I.D. I(a) <br /> L <br /> A <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minimum per facility) • $424.00 minimum <br /> f <br /> R REPAIR FEE (workplan review f construction Inspections) TANK I.D. I(aI <br /> E <br /> P TANK REPAIR FEE • $53.00 per hour (3 hours mininm/lANK) M TANK(s) <br /> Ax (159.00 $ <br /> 1 <br /> R PIPING REPAIR FEE • $53.00 per hour (3 hour minimum per fecll lty • $159.00) <br /> i <br /> M CONSULTATIONS UHAUIHORIZED RELEASE EVALUATION <br /> I SAMPLING INSPECTION <br /> S <br /> C FEE • 153.00/hr FEE • 553.00/hr FEE 153.00/hr <br /> TOTAL DUE 1 159.00 <br /> OFFICE USE ONLY <br /> �rYYAiN wpw4YY TrMw1,1M SIMM YA""L'Iy'�ti lip 1111Y 11M 4•r r•rr•r WIMM W,114 MMYly7 w"`Y"" r'YMprIY IYAI••n nwrYllr IM1�N1�I�IiArY�A••••wr•A••.•... <br /> + <br /> �attar1�1te �Vaaa�a� aaAar ra�ar �aA.a.�.......m..am.....-... <br /> wSwFFVS I� urs'u 1cR ■ ILIG w UISCwk" MUINLVII LryF r,R /�i,J 11 xl l.11 ecu uI� t„'i �w•at <br /> w.J 'iwYiwMii)'wr:iSiL":wr7FSiiiiGit4Y:,w"w rY:r rrrw4::S:nrr•wAiTAwr^ •'• •r r <br /> ••••••••• �$wY+r""wG)Yii w irnw""Aii:$iri itr"YA:1rwwi:wiw www.....w <br /> •e MY Mr,eN MMI MtrarramMaM MIMMEMMmMMaMw MrMr MMwwwMmaM MwMM•am1eMYYeMAM MMIMM""�AMMMaM Mw MIMaaMM111MNMraM wM,r MrM <br /> EM 23 032 (REV 1/10/911 ft Pace I 1 <br />