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SAN JOIIOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY VTE NAM FACILITY CONTACT NAME <br /> F mpty �ot Robert Crow <br /> C - <br /> 1 FACILITY ADDRESS 127 N. Houston Lane SITE PHONE M with AREA CODE <br /> L (209) 334-2997 <br /> PCITY Lodi, CA. STATE ZIP 140 at SITEMK��SAAMM�� ( 1 ) <br /> A APPLICANT/BILLING NAME - APPLICAITOC 011TACTCCOW <br /> p Delta Pump-Co. <br /> L <br /> I NAILING ADORES APPLICANT PHONE M WITH AREA CODE <br /> C 046 S. . California Street (209) 466-9625 <br /> N CITY 6tockton SttAE ZIP CODE TYPE of APPLICATION <br /> T 95203 CLOSURE, INSTALLATION, etc. Removal <br /> TOTAL <br /> A <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) • $100.00 <br /> I oo /Dv z> 1 Zze' Zoo $ hod <br /> E TANK FEE • $50.00/TANK (prior to January 1,1991) $170/TANK (after January 1, 1991) <br /> F $ Tanks • 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply 7fee (or <br /> C each year app lcabl e) p D SODI /V0 I (IVLowD $ D <br /> I <br /> L STATE SURCHARGE • $56.00 each TANK (Due every 5 years) See California N i S Code, Sect{an 25287 <br /> T f Tanks_ x $56.00 1986 through 1990 -----1991 through 1996 <br /> Y (enter amount and year) $ /Z <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK LD. f(a) <br /> C <br /> L CLOSURE FEE • $53.00 per hour (3 hours miniusso per TANK) f TANK(s)__L_ X $159.00 f <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/I nspecti are) TANK I.D. /(a) <br /> R <br /> E TEMPORARY CLOSURE FEE • $150.00 each TANK 1 TANK(s) X $150.00 f <br /> P PLAN CHECK (Install. Plan Review 6 Caretruction Inspections) TANK I.D. !(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minimus per Facility) $424.00 mintaus $ <br /> R REPAIR FEE (workplan review 6 constructI i TANK I.D. !(s) <br /> P TANK REPAIR FEE • $53.00 per hour (3 hour ) M TANK(s) X $159.00 • f <br /> A <br /> R PIPING REPAIR FEE • S53.00 per hour (3 h nMdZility • $159.00) $ <br /> M TRANSFER FEE $20.00UNAL�p1�IJigR,(I�ELEA$E EVALUATION • $53.00/hr $ <br /> I <br /> C CONSULTATION FEE • $53.00/hr EfAMN(.ONI)d"jC"ON J88 UINPSIN • $53.00/hr $ <br /> TOTAL DUE f 2. ( <br /> iF11rrpp ����tF tWIY <br /> e.Pxw.�N�NTOm�&90d8 i ni ,m wweac <br /> Z 4 Z <br /> EH 23 032 (Revised 4/8/91) Page 11 �� u <br />