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f <br /> SAN JOA9UIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEl1LTH D1YS10M <br /> UNDERGROUND STORAGE TANK PROGRAJI - FEE WORKSHEET <br /> FACILITYCONN f,C TRAMeCkm�ri <br /> S FACILITY SITE NAME Connell- Motor Truck Co. , Inc. Cz <br /> I <br /> T SITE PHONE N with AREA CODE , <br /> E FACILITY ADDRESS (209)466-2411 <br /> 2211 N. Wilson Way <br /> = =STATE ZIP C(l0E M of TANKS <br /> CITY at SiTE 3A Stockton A 95205 <br /> P APPLICANT CONTACT NAME <br /> P APPLICANT/BILLING NAME Inc. Sheldon HecRman <br /> L Connell Motor Truck Co. , <br /> I APPLICANT PHONE M WITH AREA CODE <br /> C MA I L I H0 ADDRESS (209)466-2411 <br /> A 2211 N. Wilson Way <br /> N STATE Zip 000E TYPE of APPLICATION <br /> T CITY C� 95205 (Ciosure, Instattation� Removal <br /> Stockton, TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1,1991) (100.00 xxxx xxxx xxxx xxxx xxxx $ xxxxxxxx <br /> A <br /> C xxxx xxxx xxxx %%XX xXXX $ XX%XxxxX <br /> T FACILITY PENALTY FEES ASSESSED (If Appticebla) <br /> I $1701TANK (After January i. 1991) <br /> V TANK FEE $50.00/TANK (Prior to January 1,1941) <br /> E1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 <br /> 0 Tanks ■' <br /> F (muttipty p by fee for — $ <br /> A each year ePPilceble) xxxx xxxx xxxx xxxx xxxx <br /> C t <br /> 1 TANK PENALTY FEES ASSESSED %xxx %%%x xxxx xxxx xxxx <br /> L <br /> I STATE SURCHARGE ■ <br /> T 1988 through 1990 ($56) 1991 through 1996 ($56) 1997 <br /> YjNTaLoks_ x 18.00OR 1997 xxx%%%xxxxxxxxxxxxxxxxxxx%X xxxxxxxxxxxxxxxxxxxxxx% <br /> C PERMANENT CLOSURE (RemovaL or Authorized Closure-in•Ptace) <br /> TANK I.D. fl(s) <br /> L N iANK(s} x (234.00 ■ $ 702.00 <br /> 0 CLOSURE FEE a $78.00/hour (3 hours minimumJTANK} — <br /> S TANK I.D. Cs) <br /> U TEMPORARY CLOSURE (Plan Review L Inspections) <br /> R $ <br /> E TEMPORARY CL05URE FEE ■ (78.00/hour (3 hours minimum/FACILITY} $234.00 minimum <br /> P INSTALLATION PLAN CHECK (Pian Review K Construction inspect ians) TANK I.D. #(a) <br /> L <br /> AS624.00 minimum $ <br /> N PLAN CHECK FEE ■ S78.00/hour (8 hours minimum/FACILITY) <br /> R REPAIR FEE (Workplan Review t Construction Inspections) <br /> TANK I.D. N(s) <br /> E # TANK(s) X $234.00 $ <br /> P TANK LINING REPAIR FEE ■ S78.00/hour (3 hours minimum/TANK} <br /> A ys $234.00 minimum : <br /> I TANK RETROFIT REPAIR FEE • 578.00/hour (3 hours min./FACILITY) <br /> R5234.00 minimum S <br /> PIPING REPAIR FEE $7f;.04fhour (3 hours roinimYNFACILITY) <br /> M TRANSFER FEE $20.00 UNAUTHORIZED RELEASE EVALUATION <br /> Y S78.00/hr = <br /> I <br /> S $ <br /> C CONSULTATION FEE ' $78.00/hr SAMPLING INSPECTION FEE _ $78.00/hr <br /> TOTAL DUE $702.00 <br /> FOR OFFICE USE ONLY nw tlunl.Imunni111:1i1nilmuuuuneun 11HIIIlIIlUtnlil§Pi1li!!illillllilillll!II{;;IFnI!IllIi IRPStl IWWIf111PU!i11tl111!pmmilllll11��11111I i1�IIIIIWtltltl�lllllllllllll'FYIItECHFIIRIItlllllll11 <br /> illl33mklll�lll <br /> ryIe I pryir 11 f III III I �pp� 1111��pg�I p �p <br /> f111111��11111LI11.I�1111�IM111'11j�lllu�pp��� I II WIHNtlllllllllllll 111lltlIIIII111W91tl1111111€S311ll1fIM1HIiIn)tlI1111111111fU1111111131i31191I1S9ii4S1i4HItlIIIII11111111E1f!Illi 11 <br /> SWEEPS M COMPUTER M LOC CODE DIST CODE AMOUNT RECEIVED CHECK N/CASH RECEIVED BY DATE RECEIVED <br /> $ lyI'WllilllllliillC4111tltlnl!liiF#I111114l111ilIlIIIII]mFlBIIS1LL.11I11E3lEIIIIIII11�1;� Ii1111111d1111iIIliU <br /> I Illlllll��#lllll�lfi�IIIfIIIIIJI��{1i111111111111149fIiliEi' l li�lllllllll�'I�I7I;IJIIiIIIC�tl�'�"l <br /> EH 23 032 (REVISED 5-27-97) <br />