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CACUIN 1"T, PUBLIC HEALTH SERVICES <br /> EHVIRCNMEHTAL HEALTH 01VISt CN <br /> CANOE. <br /> JkHO STCRAG-E TANK PRCGRAN - FEE wCRKSHEET <br /> FACILITY SITE NAME FACILITY CHTACT NAME <br /> A BUNZL FOODSERVICE RON TIEG <br /> I FACILITY ADDRESS SITE PHCNE 9 with AREA CODE <br /> L 4276 N TRACY BLVD. TRACY CA. 95376 ( 209) 836-6400 <br /> 1 <br /> T CITY STATE ZIP CME S of TANKS <br /> T tracy ca 95376 at SITE ONE <br /> A APPLICANT/BILLING NAME APPLICANT CCHTACT RAME <br /> P <br /> P PREMIER RESOURCES STEVE TRAWEEK <br /> L <br /> I MAILING ADDRESS e APPLICANT PHCNE S WITH AREA CODE <br /> C 916 366 9533 <br /> A <br /> STATE ZIP CME TYPE of APPLICATION <br /> T <br /> CITYSTATE <br /> OF INDUSTRY CA 91 744 CLCSI.RE, INSTALLATION, etc. CLOSURE <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 S <br /> V <br /> TANK FEE • S50.00/TANK (prior to January 1,1991) 2170/TANK (after January 1, 1997) <br /> F 0 Tanks • 1986 1987 1988 1989 11990 1991 1992 1993 11996 11995 1996 <br /> A (multiply 3S Cy fee for <br /> C each year appllCAble) S <br /> I <br /> L STATE SURCHARGE r 256.00 each TANK (Due every S years) See California H t S Code, Section 25287 <br /> I <br /> T 0 Tanks x 256.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) <br /> S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-P(ace) TANK I.D. CO <br /> C <br /> L CLOSURE FEE • 553.00 per hour (3 hours minima per TANK) t TANK(s) ,, X 5159.00 5 1 5 9 <br /> 0 <br /> S <br /> U TEMPCRART CLOSURE (A oro-time permit, for review/inspections) TANK I.D. 0(s) <br /> R <br /> E TEMPCRARY CLOSURE FEE • 2150.00 each TANK / TANK(s) _X $150.00 • S <br /> P PLAN CHECK (Install. Plan Review L Construction Inspections) TANK t.D. fit) <br /> L <br /> A <br /> H PUN CHECK FEE - $53.00 per hour (8 hours minimae per Fecility) • 5626.00 mininn S <br /> R REPAIR FEE (workptan review L construction inspections) TANK t.D. I(s) <br /> P TANK REPAIR FEE • 253.00 per hour (3 hours minimm/TANK) 0 TANK($) _ X 2159.00 • S <br /> A <br /> I <br /> R PIPING REPAIR FEE • S53.00 per hour (3 hour minima per facilfty • 5159.00) S <br /> M TRANSFER FEE • 520.00 UNAUTHORIZED RELEASE EVALUATION • 553.00/hr ' S <br /> I <br /> S <br /> C CCNSULTATICN FEE • S53.00/hr SAMPLING INSPECTICH FEE • 553.00/hr �a S <br /> ., TOTAL DUE <br /> CFFICE USE ONLY <br /> .v v _ w7 ti air Bair —ir ae <br /> Sara Barr r.s•r iriis�r•ri ra•si•wa rr srrs�r•r�larar swan Mwalrra•aw r•r air•ra�•r a•ata•v�r�a•rss <br /> EH 23 032 (REV 6/8/911 ft Pace 11 _— <br />