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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAMEFA ILITT CONTACT NAME <br /> y r/ Co N c�►o Co , T U r to v R <br /> I FAC DOREL� w Y IN RHONE �th AREA DE <br /> 3 <br /> YCITY 1 �� 1 (v l �, !TATE 'IS CODE 2 6 (�J et SITENKS 1 <br /> A APPLICANT/BILL1 G`NAME ? APPLICANT CONTACT NAME <br /> I L- ,J <br /> I MAIi G ADDRESS APP CAN PHONE M 4I iH ARE CODE <br /> 3 w_ o - - 6s3 <br /> N CITY I $,TATE P CODE TYPE of APPLICATION <br /> T S `(arj CLOSURE, INSTALLATION, etc. <br /> TOTAL <br /> A <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br /> I 5 <br /> V <br /> E TANK FEE 250.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F s Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply W-Ey <br /> S <br /> C each year app <br /> I <br /> L STATE SURCHARGE = 556.00, each TANK (Due every 5 years) See California H L S Code, Section 25287 <br /> I N Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> T (enter amount and year) $ <br /> PERMANENT CLOSURE (Removal or Authorited Closura1EPlate) TANK I.D. !(s) <br /> L CLOSURE FEE • S53.00 per hour (3 hours ml nimm per TANK) .! TANK(s)_j_ % $159.00 <br /> 0 <br /> U TEMP07ARY CLOSURE (A one-time permit, f6r review/inspection.) TANK I.D. !(s) <br /> R <br /> E TEMPORARY CLOSURE FEE _ !150.00 each TANK N TANK(s) _ % $150.00 = f <br /> PPLAN CHECK (Install. Plan Review 6 Construction Inspections) TANK LD. !(s) <br /> L <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minimum per Facility) = $424.00 minimm f <br /> R REPAIR FEE (workplan review d construction Inspections) TANK I.D. !(s) <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimum/TANK) 0 TANK(s) _ X $159.00 = f <br /> A <br /> R PIPING REPAIR FEE = 953.00 per hour (3 hour minims per facility = 2159.00) f <br /> MI TRANSFER FEE = $20.00 UNAUTHORIZED RELEASE EVALUATION = $53.00/hr f <br /> I <br /> C CONSULTATION FEE _ 153.00/hr SAMPLING INSPECTION FEE = S53.00/hr f <br /> F'F%F- ppb TOTAL DUE wp1y�fyn �y pSp9��y_Q(7O <br /> hr ..(1 txt�s":tmu� r mim IV AIt�t�C �I Vt U�um�.T.� <br /> WINE <br /> 03 (REV 4/8/94-1t Pe9a 11 <br />