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p 4`J <br /> T <br /> 1992 <br /> ' AUS 1 P�KEPI�N `Q >"PCU N <br /> EN ER`110E5 �P� , <br /> E;VVIRON�!S pNMEN R�IGE� <br /> FERMI c:N� I�I�� <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> X725, f�CS /� « 1l oGJC r l�S <br /> I FACILITY ADDRESS SITE PHONE with AREA CODE <br /> �Y7 6 S ` P/eGr s r <br /> T CITT / SE ZIP CODE M TANKS <br /> Y G c�C�. TATat 217ofE <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P / <br /> P I'Z.P CeS <br /> L <br /> I NAILING ADDREBB APPLICANT PHONE t WI7H AREA CODE <br /> C <br /> A <br /> N CITY STATE ZIP CODE "PE-3f-APPL I CAT ION <br /> CLOSURE, INSTALLATION, etc.s <br /> TOTAL <br /> A <br /> C 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) • $100.00 5 <br /> V <br /> E TANK FEE • 550.00/TANK (prior to January 1,1991) 2170/TANK (after January 1, 1991) <br /> F s Tanks 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply T6—fee for <br /> C each year applilcable) 5 <br /> 1 <br /> LSTATE SURCHARGE • $56.00 each TANK (Due every 5 years) Sea California H d S Code, Section 25287 <br /> i s Tanks_ x 556.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) , <br /> PERMANENT CLOSURE (Removal or Authariied ClosUre-in-Plate) TANK I.D. !(a) <br /> C <br /> L CLOSURE FEE • $53.00 per hour (3 hours minimum per TANK) R TANK(s)_ X 5159.00 S <br /> 0 <br /> S , <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections)Bets) <br /> D. !(s) <br /> R <br /> E TEMPORARY CLOSURE FEE • $150.00 each TANK X $150.00 • 5 <br /> PPLAN CHECK (Install. Plan Review i Construction Inspections) I TANK I.D. !(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minims per Facility) • 5424.00 minimum S <br /> E TANK REPAIR FEE (workplan review L construction Inspections) 17D- /(s) <br /> P TANK REPAIR FEE • $53.00 per hour (3 hours minimm/TANK) t TANK(s) X $159.00 • Ell A <br /> R PIPING REPAIR FEE • $53.00 per hour (3 hour minimum per facility $159.00) <br /> M TRANSFER FEE • 520.00 UNAUTHORIZED RELEASE EVALUATION • 553.00/hr S <br /> I <br /> C1 CONSULTATION FEE • 553.00/hr SAMPLING INSPECTION FEE • 553.00/hr If <br /> rrll��FF11rrFF ���� pp TOTAL DUE S <br /> ammmwR�n!1�PtAmW m <br /> ei !alwch.Lt nen mn a mwxmmr ummm mmummnwwmmnwbu..... xv mmmmw�mn�mcie <br /> EN 23 032 (Revised 4/8/91) Page 11 <br />