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141 <br /> w <br /> DATE CHECK No. CrIECK,RlU1MNT <br /> PAY Feb . 18 , 1992 1470 477 . 00 <br /> Four hundred sevent=y seven and no/100 <br /> ro San Joaquin County Public Health Service <br /> TI it <br /> al�nrr+ ' <br /> u'DD L4 7[]Ha �: L � LDOD � 581: L48 L ��++DD6D 3tte <br /> SAN �RONMENTCOUNTY PUBLIC HEALTH SERVICES <br /> AL HEALTH DIVISION <br /> UNI ORAGE TANK PROGRAM - FEE T70RKSHEET <br /> FACILITY SITE NAME <br /> FACILITY CONTACT NAME <br /> Tuff Boy Salesr Inc. Bill Duncan <br /> FACILITY ADDRESS SITE PHONE # uith AREA CODE <br /> 3870 W Yosemite Ave <br /> CITY STATE I(P COD@ Ato51rENKS 3 <br /> r Lathrop Ca 95330 <br /> l APPLICANT/BILLING NAVE APPLICANT CONTACT NAME <br /> Same Same <br /> L APPLICANT PHOO 0 WITH AREA CODE <br /> 1 MAILING ADDRESS <br /> C <br /> N <br /> CITY STATE ZIP CODE CLOSURE,AINSTALLAOTION, etc- Closure <br /> T <br /> TOTAL <br /> A 1986 1987 1488 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to Januehy 1, 1991) ■ !100.00 ! <br /> E TANK FEE ■ 150.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> 1986 1997 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (nittiply 7 y. 6 for ! <br /> C each year sppt1csbte) <br /> I STATE SURCHARGE ■ 156.00 each TANK iDue every 5 years) See Cetifornie NLS Code, Section 25297 <br /> 1 <br /> N Tanks x 156.00 1986 through 1990 1991 through 1996 <br /> T <br /> Y (enter amount and year) �_ ! <br /> PERMANENT CLOSURE (Removal or Authorized Closure-In-Place) TANK I.D. #(s) <br /> C <br /> L CLOSURE FEE ■ 153.00 per hour {3 hour! Ininlli,s.s+l per TANK) at! TANK(s) 3 X !154.00 • ! 77 .0 <br /> 0 <br /> RTEMPORARY CLOSURE (A one-tl,ne PertAit, f6r "V1ew/Inspectlom) TANK 1.0. 111 - <br /> E TEMPORARY CLOSURE FEE 9150.00 each TANK # TAN (0 X !150.0) + ; <br /> JAA <br /> PLAN CHECK (Instep. Pian Revieu ! Construction Inspections) TANK I.D. #(s) <br /> ! <br /> PLAN CHECK FEE - 153.00 per hbur (<s=houriInIrFlurs per Fetlilty) ■ !424.00 minl" <br /> R REPAIR FEE (uorkplen review L constructi6m InapectlIN TANK I.D. #(e) <br /> P TANK REPAIR FEE • 153.00 per hour (3 hoUrA hllAerMTAN <br /> K) N 1ANK(s) <br /> X !159,00 ■ <br /> A ! <br /> R PIPING REPAIR FEE • 153.00 per hour (3 hour IhInImllB per facfility ■ !159.00) <br /> M TRANSFER FEE !20.00 UNAU1NORl2ED RELEASE EVALUATIOEm *t-53.01E10/hr <br /> IC CONSUL1AtION FEE ■ 153,00/fir SAMPLING INSPECTION FEE <br /> TOTAL DUE $477 - <br /> 0 0 <br /> IP m <br /> r ' r <br /> "7-- <br /> C*C <br /> lllllltlllflIU <br /> f.=.- <br /> IM <br /> I e nnl n olq ,n <br /> Page <br /> ER 23 032 (REV 4/8/91) ft 11 <br />