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i <br /> JUL 2 8 1992 <br /> ENVPE NN{M S RAL{CES FFAUi i <br /> SAN JOA9UIM COUNTY pUfLIC HEALTH SERVICES <br /> ENVIRONMENTAL NEALiN DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> t ACILITY SITE NAME FACILITY CONTACT NAME <br /> SII rn CILI iY ADDRESS ITE P E ! with AREA CODE — <br /> Z 33 �ocwL �J�O �2C`v o <br /> I -1Y STATE LIP CODE � off <br /> STANKS / <br /> �. �S2a S� <br /> a APPLICANT/BILLING NAME APPUCAMT CONTACT NAME <br /> r ITocic tiv ��s V( <br /> L OD <br /> APPLICANT PHONE !.WITH AREA CE <br /> I ,uttl IMG REST <br /> � <br /> 1 Los -:x. <br /> x CIT C SlATE ZIF CISO CLPOSUREE of,APPLICATIOINSTALLATTINON, etc. A <br /> I r��� r, <br /> —" _ TOTAL <br /> A '- -- 1986 1987 1988 1989 1990 <br /> 1 ANNUAL FACILITY FEE (Prior to January 1, 1997) • 5100.00 f <br /> I <br /> F TANK FEE 550.00/TANK (prior to Jeruery 1,1991) <br /> 5170/YANK (after Jenuery 1, 1991) <br /> F s Tanks 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> (Multiply T-13y — )r f <br /> ench year app _ <br /> l STATE SURCHARGE _ 156.00 each TANK (Due every 5 years) Sea California N L S Code, Section 25287 <br /> I1991 through 1996 <br /> a ienks x 556.00 7986 through 1990 <br /> r `(enter ama+rt end year) - S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. f(q <br /> __ <br /> 1. CLOSURE FEE _ 153.00 per hour (3 hours mini" per TANK) f TAMK(s)__ X f159.00 <br /> u iFHPORARY CLOSURE (A one-tlne permit, for review/inspections) TANK I.D. <br /> R __— <br /> E TEMPORARY CLOSURE FEE • S150.00 each TANK f TANK(s) _ X $150.00 = <br /> r PLAN CHECK (Install. Pier, Review L Construction ITupectlons) TANK I.D. #(a).- <br /> PI <br /> (a)_ <br /> v _PLAN CHECK FEE - 153.00 per hour (8 hours minidmza per Faciltty) • SA24.00 minim f <br /> o REPAIR FEE (workplan review L construction Inspections) TANK t.D. f(s) <br /> P LANK REPAIR FEE • 553.00 per hour (3 hours miniNLWTANK) f TANK(s) -_C-- <br /> AN <br /> 1( (159.00 • S <br /> _. <br /> m PIPING REPAIR FEE = 153.00 per hour (3 hour ■I nteus per facility f159.00) <br /> MI TRANSFER FEE • $20.00 UNAUTMORIZEO RELEASE EVALUATION • 553.00/hr <br /> I tIL ---r-j— d <br /> =CONSULTATION FEE 553.00/hr —I SUIPLINI INSPECTION FEE • 153.00/hr I f <br /> TOTAL DUE f' S <br /> y <br /> ca: � - I�RTECE IVED` <br /> :I EPS li� ������ <br /> 1 � � W <br /> � .:�- .�^+^r^Rc. <br /> .. . .:.d Ji!�Giil!ili�l':BiYYi&9tliY®IW I® <br /> m 7[ 032 (Revised 4/8/91) Page 11 <br />