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APR 19 1993 <br /> ENVIRONMENTAL HEALTH <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES PERMIT/SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE 1KIRKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> C WILLIAM VALENCIA <br /> NONE <br /> IFACILITY ADORESS 3507 STEVINSON STREET SITE PHONE # with AREA CODE NONE <br /> 1 ATE 2 # of TANKS <br /> T CITY �A at <br /> Y STOCKTON SITE Two (2) <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P WILLIAM VALENCIA WILLIAM VALENCIA <br /> L APPLICANT PHONE #948 W3WITH AREA CODE <br /> I MAILING ADDRESS 912 S. CALIFORNIA ST, <br /> C <br /> A <br /> ��rrATE ZIP TYPE of APPLICATION <br /> N CITY STOCKTON l,A 9!65 CLOSURE, INSTALLATION, etc. REMOVAL <br /> TOTAL <br /> A <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) - S100.00 S <br /> I <br /> V <br /> E TANK FEE 250.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F 0 Tanks - 1986 1987 1988 1989 1990 1 1991 1992 1993 1994 1995 1996 <br /> A (multiply y�yfee for $ <br /> C each year applicable) <br /> L STATE SURCHARGE - $56.00 each TANK (Due every 5 years) See California H b S Code, Section 25287 <br /> I <br /> I # Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) I IS <br /> PERMANENT CLOSUR (Removal or Authorized CLosure-in-PLace) TANK I.D. #(s) <br /> L CLOSURE FEE _ 20.00 per hour (3 hc x 5or00 23`(- 5 4✓0� <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TAIL I.D. #(a) <br /> R <br /> E TEMPORARY CLOSURE FEE - $150.00 each TANK I # TANK(s) _ X $150.00 S <br /> P PLAN CHECK (Install. Plan Review 8 Construction Inspectias) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK <br /> FEE - 353.00 per hour (8 hours minimus per Facility) = $424.00 minimum S <br /> R REPAIR FEE (workplan review 8 construction inspections) TANK I.D. #(s) <br /> E <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimm/TANK) # TANK(s) X $159.00 = S <br /> A <br /> I S <br /> R PIPING REPAIR FEE = $53.00 per hour (3 hour minimus per facility = S159.00) <br /> M TRANSFER FEE $20.00 UNAUTHORIZED RELEASE EVALUATION - S53.00/hr S <br /> I <br /> S <br /> C CONSULTATION FEE = S53.00/hr SAMPLING INSPECTION FEE - S53.00/hr S <br /> TOTAL DUE S 4 <br /> H <br /> —sGEEPS ' CCNPU7ER OC CCO tC C00 OL1i11^R AEt lIC EGECVED-9 ACEECE'CVE - <br /> y <br /> E4 23 032 (Revised 4/8/91) Page 11 <br />