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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES 00A <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> C21 <br /> SITE NAME FACILITY CONTACT NAME <br /> F <br /> 0. E <br /> 1 �ouTH HIGHWAY 99 r`7Tj,(71H JS9REA CODE <br /> YA �9LATE ZIP C[AE\_Ll1Ji La ofTANKS <br /> l,A at SITEA /BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> PaIDRESSOUTH HIGHWAY 99 ��� AR��� I ITH AREA CODE <br /> TA SNE ZIP CODE TYPE of APPLICATION <br /> CLOSURE, INSTALLATION, etc. <br /> C.LO URE <br /> TOTAL <br /> A 1986 1987 1988 1989 1990 <br /> C <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = 2100.00 S <br /> 1 <br /> E TANK FEE 550.00/1"ANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F # Tanks 1986 1987 1988 1989 1990 1991 1.1992 1993 1994 1995 1996 <br /> A (multiplyi1Tiy fee for S <br /> C each year applicable) <br /> I 25287 <br /> L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H 3 S Code, Section <br /> T # Tanks x 556.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. !(s) <br /> L CLOSURE FEE = 253.00 per hour (3 hours minima per TANK) 0 TANK(s) ONE K $159.00 S ' <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A are-time permit, for review/inspections) TA)DC I.D. !(s) <br /> R 1 ! TANK($) _ % f150.00 = S <br /> E TEMPORARY CLOSURE FEE = 2150.00 each TANK <br /> P PLAN CHECK (Install Plan Review b Construction Inspections) TANK LD. !(s) <br /> L <br /> A2424.00 minimum S <br /> N PLAN CHECK FEE - 253.00 per hour (8 hours minimus per Facility) = <br /> R REPAIR FEE (workplan review S construction inspections) TANK I.D. !(s) <br /> E # TANK(s) x $159.00 = S <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minin&WTANK) <br /> A <br /> R PIPING REPAIR FEE = 253.00 per hour (3 hour minimun per facility = 2159.00) S <br /> M TRANSFER FEE 520.00 UNAUTHORIZED RELEASE EVALUATION 253.00/hr $ <br /> I <br /> S <br /> CONSULTATION FEE = S53.00/hr SAMPLING INSPECTION FEE = 253.00/hr f <br /> TOTAL DUE $ <br /> 'q -$GEEk�jD. - (WPOTE Cbl: 2T {fT-fi AEC 7 CEC D g T FIVE6'�� <br /> '. a <br /> EH 23 032 (Revised 4/8/91) Page TWO ' <br />