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SAN JOAQUIN CQ1MtY�tC HEALTH SERVICES - ENVI0.0NNENTAL HEALTH TOM <br /> UNOEq STartADE TANK PROGRAM - TEE tA7RKSNEET ., <br /> �1LITY 111E HANE FACILITY CONTACT NAME <br /> Rae N. Margrave (formerly City Crab) Sharon Renschler 3 <br /> ACILIty ADDAt9l SITE PHONE S Nlth AREA CODE <br /> 510 E., Lodi. Ave. N A <br /> ITT STATE ZIP CODE 1 of TANKS <br /> Lodi, CA 95240 at SITE 1 <br /> PPUCANt/BILU HO NAME APPLICANT CONTACT NAME <br /> Rae N. Margrave Sharon Renschler 1, <br /> NAIL IMO ADDRESS APPLICANT PHONE N WITH AREA CODE <br /> 6247 E. Jahant Rd. <br /> CITY STATE ZIP CODE TYPE of APPLICATION <br /> Acampo, CA 95220 (Closure, Irotallatlen, eta.) Removal <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prier to January 1, 1991) • 1100.00 ! - <br /> FACILITY PENALTY FEES ASSESSED (It Applleebl e) <br /> xxxx xxxx ! <br /> TANK FEE 150.00/LANK (Prior to January 1,1991) 1170/LANK (After January 1, 1991) <br /> R tanks • 1986 1987 I 1968 1 1969 1990 1991 1992 1993 1994 1995 1996 <br /> (multiply fee For 1 <br /> each year appllteble) <br /> 1 <br /> TANK PENALTY FEE! ASSESSED xxxx xXXX . <br /> STATE SUACNARGE + $56.00 each LANK (Due every S years) See callfornla H d 1 Cade, section 25297 <br /> R tanks x 156.00 1986 through 1990 1991 through 1996 <br /> moun <br /> (Enter at end year) 1 <br /> PERMANENT CLOSURE (Removal or Authorlied Closure-In-Place) TANK LD. R(a) <br /> CLOSURE fEE + 17A.00/hour (3 hour! mInIAAm/TANK) <br /> R TANK(a)i x !234.00 <br /> SA(!) <br /> U TEMPORARY CLOSURE (Plan RWIeN R Inspletlon!) TANK I.D. <br /> R . ! <br /> E TEMPORARY CL09URE FE! • 578.00/hour (3 hour! mInIRAm/TANK) A tANk(s)__ <br /> P INSTALLATION PLAN CHECK (Plan Review L Construetlon Inlpeetlens) TANK I.D. A(!) <br /> L <br /> A . 1624.Otl min Imus 1 <br /> N PLAN CNEcK FEE a 578.00/hour (8 hour! minimus/FACILITY) <br /> R REPAIR FEE (Vorkplan KAY144 R Construetlon Inspections) PARK LO. A(!) <br /> E <br /> P TANK LININO REPAIA f1l a 178.00/hour (3 hours minimae/TANK) IT TANK(!) % 1234.00 <br /> A5234.00 minims 1 <br /> I TANK REtAOFIT REPAIA FEE + !78.00/hour (3 hours min./fActLltY) <br /> % 1 <br /> PIPING REPAIR FEE • 1:78.00/hour (3 hours minimm/fACILitY) a 1234.00 minimus <br /> N TRANSFER TEE <br /> • 120.00 UNAUtNoAl2ED RELEASE EVALUAtION * !78.00/hr 1 <br /> I <br /> S • 17A.00/hr 1 <br /> c CONSULtA1toN FEE a 178.00/hr SAMPLING INSPECTION FEE <br /> TOTAL OUR <br /> FOR OFFICE USE ONLY <br /> A. <br /> SVEEPS A COMPUTER 0 LOC CODE 01St CODE AMOUNT RECEIVED CHECK A ASN R CEIVED AY DATE RECEIVED <br /> 3 /Qt !jlllljjj <br /> -� <br /> !o <br /> EN 23 032 (REVISED 11-1.92) <br /> Page 11 1 a <br />