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SAN JOAQUIN COUNTY PUBLIC REALTR SERVICES <br /> ENYIRONb1ENTAL BEALTR DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM -FEE WORKSHEET <br /> FACILITY CONTACT HME <br /> I FACILITY SITE NAME cJ <br /> c) SITE PHONE # With AREA CODE K y <br /> E FACILITY ADDRESS '`-�',a,1 �� ) i� <br /> # of TANKS <br /> ACITY R,Yy1 �T/>;7E ZiP�ODb at S1TE <br /> P u v C-1� `1� APPLICANT CONTACT NAME <br /> APPLICANT/BILLING NAME <br /> L n 1 ./f./) <br /> IW IV Fi'` I APPLICANTPHONE # WITH AREA CODE <br /> I <br /> C MAILING ADDRESS O'1 <br /> A , 1 S� Zip E TYPE °f APPLICATION. <br /> # (Closure, Installation, etc.) 'E <br /> T CITY (�yrt�.r� TOTAL <br /> 5170/TANK (After January 1, 1991) <br /> Cl TANK FEE = 550.00/TANK (Prior to January 1,1991) <br /> 1 992 <br /> T # Tanks = 1986 11987 11988 11989 1990 1991 1 11993 i 1994 11995 11996 S <br /> I (multiplyca6l e)r XXXX XXXX I XXXX XXXX XXX:( I S <br /> Y each year app <br /> E TANK <br /> 1 STATEDENALTY SURCHARGE <br /> ASSESSED <br /> ealhwT NK (D a Ixxxxv 5l years) see S�California N 8 S Code, Section 25287 <br /> T 1991 through 1996 <br /> 1986 through 1990 s <br /> E xEncersamountXand6year) <br /> TANK l.D. #(s) <br /> C PERMANENT CLOSURE (Removal ar Authorized Closure-in-Place) I # TANK(s) X 5234.00 = s 1 �7 <br /> L c_ _ 578.00/hour (3 hours minim,m/TANK)__ <br /> 0 CLOSURE F� I TANK I.D. #(s) <br /> S tins) <br /> U TEMPORARY CLOSURE CP tan Review d [nsPe° 5234.00 miniaam <br /> R <br /> E� <br /> TEMPORARY CLOSURE FEE = 578.00/hour (3 hours minim,m/FACILITY) <br /> P INSTALLATION PLAN Construction Inspects°ns)I TANK I.D. <br /> CHECK (Plan Review 8 #(s) S <br /> L <br /> minimum/FACILITY) = 5624.00 minimum <br /> A <br /> M� PLAN CHECK F"c2 = 578.00/hour (8 hours <br /> TANK [ 0 #(s) <br /> ER ::=� <br /> rkplan Review b Canscructn°^ Inspections) I # TANK(s) X 5234 00 I?AIR FEE = 578.00/hour (3 hours minimum/TANK) _ 5234.00 minim,m <br /> REPAIR F"cE = 578.00/hour (3 hoursmin.lFACILi 5234.00 minimumS <br /> -FE'c = 578.00/hour (3 hours minimum/FACILITY) <br /> N TRANSFER FEE = 520.00 INAUT14CRIZED RELEASE EVALUATION = 578.00/hr I I S <br /> 1 = 578.00/hr S <br /> C CONSULTATION FEE = 578.00/hr I SAMPLING INSPECTION FEE I I <br /> TOTAL DUE <br /> CGD�OTST COUETAMWN�'�EL�IVED�CN�.CI�GSN �tc�L�ED 3Y �I DA(l�Rc�Cc'fIVET�- <br /> a <br /> EH 23 046 (Revised 7/10/96) <br /> Page I1 <br />