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%AaI 11"/ <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONWIENTAL HEALTH DMSION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> 5 ,FACILITY SITE NAME FACILITY CONTACT NAME <br /> `r L <br /> E FACILIT ADDRESS SITE PHONE : with AREA CODE J <br /> 8ZqC2� _ _ L L <br /> A CITY �TATEI ZIP CODE ( <br /> atoSlTc'TANKS <br /> P. S QCl a J <br /> PI APPLICANT/BILLING NAME1. pPPLICANt_CONTACT NAME I <br /> L MAILING A r� <br /> I <br /> I RESS _ APPLICANT PHONE R' WITH AREA CODE_ <br /> N <br /> T CITY I STATEI 2[P CODE YIE of APPLICATION <br /> I �CLosure, Installation, etc.) <br /> TOTAL <br /> i Aj TANK FEE = 550.00/TANK (Prior to January 1,1991) 3170/TANK (After January 1, 1991) <br /> TI - Tanks = L 1986 1987 11988 1989 11990 11991 1992 11993 11994 11995 1996 <br /> II (multiply a—oyy fee for l <br /> V� each year applicacle) r XX%% Xx%X XXXX XXXX XXXX I I I I I S i <br /> i TANK PENALTY FEES ASSESSED XXXX XXXX XXXX I XXXX I XXXX I I I I I S <br /> S <br /> II STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> T' <br /> E " Tanks x 356.00 1986 through 1990 1991 through 1996 <br /> ('Enter amount and year) <br /> S <br /> L1 PERMANENT CLOSURE (R.,,,.L or Authorized Closure-in-Place) I TANK I.O. C(s) <br /> 0' CLOSURE FEE = 578.00/hour (3 hours mininnm/TANK) 9 TANK(s)� X 5234.00 = 15 3 GG <br /> S _ <br /> Ui TE.MPORARY CLOSURE (Plan Review 8 Inspections) I TANK I.D. :(s) �— <br /> 'ei TEMPORARY CLOSURE FEE = 578.00/hour (3 hours mini mom/FACILITY) I SZa'4,C0 mi nimun S { <br /> P1 INSTALLATION PLAN CHECK (Plan Review 3 Construction Inspections)I TANK I.D. :(s) -- <br /> L' <br /> A <br /> Nl PLAN CHECK FEE = 578.00/hour (8 hours minimum/FACILITY) = 5624.00 minimum 5 <br /> Ei REPAIR FEE (Workplan Review 8 Construction Inspections) TANK I.D. S(s) <br /> Pj TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) X TANKCS) X 5234.00 = $ <br /> A <br /> I TANK RETROFIT REPAIR Fc`= = 578.00/hour (3 hours min./FACILITY) = 5234.00 minimum S — <br /> RI ?IPING REPAIR FEE = 58.00/hour (3 hours minimum/FAC:LITY) = 5234.00 minimum $ -- <br /> HI TRANSFER 327.70 j 'UNAUTHORIZED RELEASE EVAL'JATTCN = 578.00/hr I j —— I S <br /> i' <br /> 3� <br /> CCNSUL-Ai:CN =E 378.00/hr i SAMPLCNG INSPEC7:CN ? = S73.90/hr <br /> u <br /> TOTAL DUE <br /> T C:0€ I iMCUN"�2E�'-�`.'!EJ i :3'�_.. DA <br /> _ —r c 2uc_ic7 _ <br />