Laserfiche WebLink
UIN <br /> UBLIC HEALTH <br /> SOEPQMRONAD?NTALP HEALTH DIVISION �� <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> I Janet E. Woods/Kathleen A. Merkel Pat M rk <br /> E FACILITY ADDRESS SITE PHONE # with AREA CODE (Z09)477-1232 <br /> 1912 Waudman Ave. y 7{ /gyp( <br /> A "Ty CATO 752 • ,.S TA�1:... 1 <br /> Stockton, at SIZE <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME Pat Merkel <br /> L Same as above <br /> I APPLICANT PHONE # WITH AREA CODE <br /> C MAILING ADDRESS <br /> A <br /> N STATE ZIP CODE TYPE of APPLICAT tON <br /> T CITY (Closure, Installation, <br /> TOTAL <br /> A TANK FEE = S50.00/TANK (Prior to January 1,1991) E170/TANK (After January 1, 1991) <br /> C 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> T # Tanks = <br /> I (multiply ��y fee for S <br /> —LIE]= <br /> V each year applicable) X%XX %XXX XXXX XX%% %%%% <br /> E S <br /> TANK PENALTY FEES ASSESSED %%%X XXXX X%X% XXXX X%%X <br /> 5 <br /> T STATE SURCHARGE = 556.00 each TANK (Due every 5 years) See California H d S Code, Section 25287 <br /> E # Tanks x 556.00 1986 through 1990 1991 through 1996 IrW'a'03b <br /> (Enter amount and year) X }( 5112.00 <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) InV'D 5 bu <br /> 0 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s)_a_ % $234.00 = 5234,00 <br /> STANK I.D. #(s) <br /> U TEMPORARY CLOSURE (Plan Review A Inspections) <br /> RS <br /> E TEMPORARY CLOSURE FEE 578.00/hour (3 hours minimus/FACILITY) E234.00 mini" <br /> Pj INSTALLATION PLAN CHECK (Plan Review 8 Construction Inspections) TANK I.D. #(a) <br /> L <br /> A = 5624.00 minimum <br /> S <br /> X PLAN CHECK FEE = 578.00/hour (8 hours minimum/FACILITY) <br /> R REPAIR FEE (Workplan Review A Construction Inspections) TANK I.D. #(s) <br /> P TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) _ X $234.00 = S <br /> A % <br /> 1 TANK RETROFIT REPAIR FEE - E78.00/hour (3 hours min./FACILITY) = $234.00 minium <br /> R = S234.00 minimus S <br /> PIPING REPAIR FEE = E78.00/hour (3 hours minium/FACILITY) <br /> N TRANSFER FEE 520.00 UNAUTHORIZED RELEASE EVALUATION - $78.00/hr S <br /> I <br /> C CONSULTATION FEE = 578.00/hr SAMPLING INSPECTION FEE = 578.00/hr S <br /> TOTAL DUE 346.00 <br /> U.S.E._QII.L.r..._ —.... ... !x:-.=.,rte !:rmm>a yr=:°*x:.:�am3, srm xs!mmm:nxnxe!a:m <br /> ....fQR.d1.F..E.I.0 . .....::—=—rs;!,,-.r::�:,::::::-r. s!x!:.c:_�*::!;!;r:::-"'_::_: _.._ __.... .: — i!!! --,__, . ,:,t!!!!;,;,!�!! <br /> r a�..... .::.. � �1'VEd i <br /> �WE�FS N LaMP . .......... .........�:,___._.:..f,!::..___::::... ` y: <br /> ... . IMP SY <br /> 6A llE <br /> n--- � UTEr( # LDO CODE DISI' cdGE AfadINY RECEIVED LAECIC #/Z��H � E <br /> ,,,:. ..= <br /> ...mhmem,.....r_!!. � <br /> unm!m^mmxx*^!m <br /> ... .. .._,:. .. .... 4.. <br /> M, <br /> EH <br /> :;P=.;,:!:!gm!�— <br /> EH 23 046 (Revised 9/11/96) Page 11 <br />