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j JUL 2 8 1992 <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <br /> SAN JOAOUN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> � b1� <br /> i FACILITY ADDRESS ITE P , E ! with AREA CODE <br /> 23 {�oewL Lr <br /> r CITY STATEI ZIP CODE R of TANKS <br /> T _..... �. r{S Zd Sr at SITE <br /> A APPLICANT/BILLING MAKE APPLICANT CONTACT NAME <br /> F <br /> I 1 UNG REBSI APPLICANT PHONE UWITH AREA CODE <br /> C lk v� <br /> A -- <br /> N CIT STATE 21P CODE TYPE of APPLICATION <br /> F r. «. C/r- ZL�( CLOSURE, INSTALLATION, etc. { <br /> – _ TOTAL <br /> A 1986 1987 1988 1989 1990 <br /> I ANNUAL FACILITY FEE (Prior to January 1, 1991) • $100.00 <br /> I f <br /> V <br /> F TANK FEE $50.00/TANK (prior to January 1,1991) 1170/TANK (after January 1, 1991) <br /> F A Tanks 1986 1987 1988 1989 1990 1991 1992 1993 1996 1995 1996 <br /> (nultiply IFfee for <br /> J anch year app lceble) S <br /> l <br /> STATE SURCHARGE 156.00 each TANK (Due every S years) Sea California H C 4 Code, Section 25287 <br /> i 9 Tanks x 156.00 90 1986 through 191991 through 1996 <br /> I –(enter 5Ra—t and year) $ <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. f(a) <br /> C <br /> L CLOSURE FEE • 553.00 per hour (3 hours minimus per TANK) ! TANK(s)_ % $159.00 f <br /> 5 – <br /> U TEMPORARY CLOSURE (A one-time permit, for review/Inspeetlons) TA1K LD. !(a) <br /> R <br /> t-EE TEMPORARY CLOSURE FEE + $150.00 each TANK R TANK(e) % !150.00 = S <br /> 1 PI PLAN CHECK (Install. Plan Review $ Construction Inspections) TA1BC LD. !(a) <br /> ,1 - <br /> N <br /> PI AN CHECK FEE - $53.00 per hour IS hours minimum per Facility) $426.00 mininsua f <br /> ; <br /> a REPAIR FEE (workplan review 8 construction inspections) TAM I.D. 1(a) <br /> P LANK REPAIR FEE + $53.00 per hour (3 hours minfmLn/TANK) A TANK(*) — X (159.00 • 3 <br /> A <br /> a PIPING REPAIR FEE + $53.00 per hour (3 hour minimum per facility : 1159.00) f/-1 00 <br /> H TRANSFER FEE + $20.00 UNAUTHORIZED RELEASE EVALUATION • 553.00/hr S <br /> I <br /> CONSULTATION FEE 553-00/hr SAMPLING INSPECTION FEE • 153.00/hr $ <br /> TOTAL DUE 1 S )0 <br /> 191i Wf7m(ia5� .P..lVi p�a <br /> i SL'�.E1i(Sv c;a:ctytR-'�,a�- ���� �1prow;.�, .ISkY'E�Yf�CE�Vf6.°,-.�.� <br /> �fC0M SER o <br /> r��;m•a, <br /> - ay v:an;:v:nvaicasvwa;xeca mm;vn -revvnumnev:vwmrmmmc.;a.s <br /> =n �5 032 (Revised 6/8/91) Page 11 <br />