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! SAN JOAC)IN COUNT LIC HEALTH SERVICES - ENVIRONMENTAL NEALT�VSIOM <br /> IINDERSTORAGE TANK PROGRAM - FEE WCRKSHEET <br /> LITY SIT NAME// FACILITY CONTACT NAME <br /> Thomas and Karen Migliori et, al. Thomas Migliori <br /> FACILITY ORE ! SITE PHONE R with AREA CODE <br /> 117 S. Stanislaus St. N/A <br /> s <br /> CITY STATE ZIP CODE R of TANKS <br /> A - Stockton, CA 95202 at SITE 2 <br /> P <br /> P APPLICANT/81LLINO NAME APPLICANT CONTACT NAME <br /> L <br /> I Thomas and Karen Mi liori Same as above <br /> C MAILING ADDRESS APPLICANT PHONE M WITH AREA CODE <br /> A 500 E. Market St. (209)464-4282 <br /> N <br /> T CITY STATE ZIP CODE TYPE of APPLICATION <br /> Stockton, CA 95202 (Closure, Installation, etc.) Removal <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prier to Jerwery 1, 1991) • 1100.00 <br /> A s <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX KXXX f <br /> I <br /> V TANK FEE • 850.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> R Tanks 1986 19871988 1989 1990 1901 1992 1993 1994 1 1995 1 1996 <br /> F (multiply N by fee for <br /> A each year applicable) f <br /> C <br /> 1 TANK PENALTY FEES ASSESSED KXXX XXXX S <br /> L <br /> I STATE SURCHARGE • 556.00 each TANK (Due every 5 years) See California N 6 S Code, Section 25287 <br /> T <br /> Y R Tanks 2 X 156.00 1986 hroug 990 X991 hrough 1996 <br /> (Enter amount and year) <br /> $ 112.00 $ 112.00 $224.00 <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. R(a) <br /> L <br /> 0 CLOSURE FEE • 1178.00/hour (3 hours minlmum/TANK) 0 TANK(s) 2 X 5234.00 • It 468.00 <br /> S <br /> U TEMPORARY CLOSURE (Plan Review 6 inspections) TANK I.D. R(a) <br /> R <br /> E TEMPORARY CLOSURE FEE • 978.00/hour (3 hours minimum/TANK) R TAHK(s) X 8234.00 • f <br /> P INSTALLATION PLAN CHECK (Plan Review R Construction Inspections) TANK I.D. f(a) <br /> L <br /> A <br /> N PLAN CHECK FEE • 578.00/hour (8 hours minium/FACILITY) • 5624.00 minimum S <br /> R REPAIR FEE (Workp(an Review A Construction Inspections) TANK I.D. /(a) <br /> E <br /> P TANK LINING REPAIR FEE • 878.00/hour (3 hours minimus/TANK) R TANK(s) X 9234.00 • f <br /> A <br /> I TANK RETROFIT REPAIR FEE • 578.00/hour (3 hours min./FACILITY) • 5234.00 minimus 5 . <br /> R <br /> PIPING REPAIR FEE • 1178.00/hour (3 hours minlmm/FACILITY) • 5234.00 minimum f <br /> N TRANSFER FEE • 120.00 UNAUTHORIZED RELEASE EVALUATION • !78.00/hr f <br /> I <br /> S ` <br /> C CONSULTATION FEE • 278.00/hr SAMPLING INSPECTION FEE • 1178.00/hr <br /> TOTAL DILE 11 0(32.00 <br /> FOR OFFICE USE ONLY <br /> hP . mama. um( :i.m nrv1asEc!��e'cemii.!!!aa :MEmM drat; '5.aaa� �!emin. ' NI <br /> 0-""'SWEEPS R COMPUTER I LOC CODE DIST CODE AMOUNT RECEIVED CHECK /CASH RECEIVED 8Y DATE RECEIVD_n,"P°mcn - n; a u; C: <br /> EN 23 032 (REVISED It-1.92) Page 11 <br /> i <br />