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ICES - <br /> SAN JOAOU IN UNDER COUNTY <br /> DERV MDI STORAGE TANKVPROGRAMENV FEEWORKSHEE IALIN DIVSION <br /> FACILITY CONTACT AltE Sallie <br /> E NAME / L <br /> Franklin Cole /1G/45 SITE PHONE N with AREA LODE <br /> y ADDRESS (209)835-1800 <br /> 505 W. Linne Rd• STATE ZIP CODE M of TANKS <br /> ,yY CA. 95376 at SITE 2 <br /> Tracy, APPLICANT CONTACT NAME <br /> p APPLICANT/BILLING NAME Sallie as above <br /> L Franklill Cole APPLICANT PHONE N WITH AREA CODE <br /> 1 (209)835-1800 <br /> C MAILING ADDRESS <br /> A P.O. Box 1114 Removal <br /> 5`�,]E 21e537 TYPE of APPLICATIONN AA y .i b (Closure, Instal letlon, etc.) <br /> T CITY Tracy, TOTAL <br /> 1906 1987 1988 1989 1990 <br /> 1991) _ $100.00 f <br /> ANNUAL FACILITY FEE (Prior to Jeruery 1, �— <br /> f <br /> A X%XX X%%% <br /> Clicebl e) <br /> 1 FACILITY PENALTY FEES ASSESSED ((f APP 1170/TANK (After January 1, 1991) <br /> V TANK FEE = 150.00/TANK (Prior to January 1,1991) 1996 <br /> E 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 <br /> P Tanks = $ <br /> F (miltiply R by fee for <br /> A each year applicable) f <br /> C <br /> I IAHK PENALTY FEES ASSESSED %XX% X%% <br /> L <br /> I STATE SURCHARGE = $56.00 each TANK (Gue every 5 years) fee Call ornia H 1991Cthrough;996 2528 <br /> T 1986 through 1990 <br /> y d Tanks_ x $56.00 S <br /> (Enter amount and year) <br /> TANK I.D. N(s) <br /> C PERMANENT CLOSURE (Remove( or Authorized Cl osure-)n-Piece) X $234.00 • % 468.00 <br /> L N TANK(s)2_ <br /> 0 CLOSURE FEE = 478.00/hour (3 hours minimus/TANK) TANK I.D. N(a) <br /> S <br /> U TEMPORARY CLOSURE (Plan Review 6 Inspections) % <br /> RACILITY) = $234.00 minimum <br /> E TEMPORARY CLOSURE FEE = 178.00/hour (3 hours minimum/F <br /> P INSTALLATION PLAN CHECK (Plan Review 6 Construction Inspect long) TANK I.D. N(s) <br /> Lf <br /> A = $624.00 mini muss <br /> N PLAN CHECK FEE = 178.00/hour (8 hours minim"/FACILITY) <br /> TANK I.D. N(s) <br /> R REPAIR FEE (Workplan Review 6 Construction Inspections) % 1234.00 = % <br /> E N TANK(s) <br /> P TANK LINING REPAIR FEE = $78.00/hour (3 hours minim"/TANK) f <br /> A = $234.00 minim" <br /> I TANK RETROFIT REPAIR FEE = 178.00/hour (3 hours min./FACILITY) _ $234.0(1 minim" $ <br /> R <br /> PIPING REPAIR FEE 178.00/hour (3 hours minimuM FACILI Y) <br /> f <br /> M TRANSFER FEE _ $20.00 UNAUTHORIZED RELEASE EVALUATION = $78.00/hr <br /> I f <br /> S = 178.00/hr <br /> SAMPLING INSPECTION FEE <br /> C CONSULiAiIOH FEE _ $70.00/hr TOTAL DUE $ 468.00 <br /> FOR OFFICE USE ONLY . .............. ..................... <br /> ...................................................................................................................................................... <br /> tgpgyt �p3 p#p �p p�gp gpy g p� 'E 'ErT�E�`�V'M <br /> �I)Ifl LU)t AI'IUIN EIVEU 'I HEJI.XI <br /> eY SUE E�5 _ <br /> a .................... <br /> Wa�imarm es aaw Ar wrwaw wra ysp,s+srw za xx avar ar... paae 11 <br /> Ell 23 032 (REVISED 3-1-931 <br />