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ICES - <br /> TAL He <br /> • SAN JOAIXIIN OOUUNDI STORAGEHTANKVPROGRAME-FEES WORNKSHEEI DIVSION <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> illie Billingsly <br /> 1 Local Laborers Union No . 73 W <br /> T SITE PHONE # with AREA CODE <br /> E FACILITY ADDRESS 209-466-3356 <br /> & 2 4 STATE ZIP CODE TA2 <br /> NKS <br /> C <br /> A tockton CA 95205 at ST <br /> P APPLICANT CONTACT NAME <br /> P APPLICANT/BILLING NAME as Above <br /> L Same as Above <br /> C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> N STATE ZIP CODE TYPE of APPLICATION <br /> T CITY (Closure, installation, etc.) <br /> TOTAL <br /> 1986 1 1987 1988 1 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 xxxx I <br /> xxxx 10 0 1 0 0 1 0 0 $ <br /> A <br /> Lxxxx I xxxx 1 100 100 100 $ <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) <br /> 15170/TANK (After January 1, 1991) <br /> V TANK FEE = 850.00/TANK (Prior to January 1,1991) <br /> E 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> # Tanks = <br /> F (multiply #Tfee for <br /> A each year applicable) xxxx xxxx 100 100 340 340 340 x 1 , 200 . 00 <br /> L 100 100 340 340 340 x $1 , 200 . 00 <br /> 1 TANK PENALTY FEES ASSESSED xxxx XX%X <br /> L <br /> 1 STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 2528 <br /> T1986 through 1990 1991 through 1996 <br /> Y # Tanks _ x $56. $ <br /> (Enter amount and year) <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) $ <br /> L # TANK(s)__ % $234.00 <br /> 0 CLOSURE FEE = $78.00/hour (3 hours minimum/TANK) <br /> 5 TANK I.D. #(s) <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) $ <br /> R <br /> E TEMPORARY CLOSURE FEE = $78.00/hour (3 hours minimum/FACILITY) $234.00 minimum <br /> P INSTALLATION PLAN CHECK (Plan Review 8 Construction Inspections) TANK I.D. #(s) <br /> L $ <br /> A <br /> minimum/FACILITY) $624.00 mini mum <br /> N PLAN CHECK FEE _ $78.00/hour (8 hours <br /> R REPAIR FEE (Workplan Review & Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE = $78.00/hour (3 hours minimum/TANK) # TANK(s) K $234.00 = <br /> A $ <br /> I TANK RETROFIT REPAIR FEE = $78.00/hour (3 hours min./FACILITY) = $234.00 minimum $ <br /> R = $234.00 minimum <br /> PIPING REPAIR FEE _ $78.00/hour (3 hours minimum/FACILITY) <br /> M TRANSFER FEE _ $20.00 UNAUTHORIZED RELEASE EVALUATION = $78.00/hr <br /> E <br /> [ $ <br /> S = $78.00/hr <br /> L CONSULTATION FEE _ $78.00/hr SAEHE <br /> MPLING INSPECTION FEE <br /> TOTAL DUE $3 7 <br /> ...._..__......_...__...:::-::::::,-.--.-:-.—::::::::!!:!!mm!!!!!!_!_�_!-!!!!!!!!!=!t!-= =!!!!t!_!!m!!!iiiiH'!�`i.`-iiiH`.:::::::::!!.:_:::.....................:,_::::max! <br /> CE US ONLY..._._._.............._.............:-:::-:::::-::::,.............._.:.:!!::::::::::-:::::...........:............::::::::::::::.........._.............::::::::::::::::-:,...._._:..:,,.,_::!:::::�:.............._ .._....:......... . .... . ....._.... <br /> FOR...OFFI......::U5.�:.::::: :::::.........:::: :::::::::::::!:........_.:::::::::::::::::::::::.:............. ::::::::::::::::::::::::...........:::::::::_::::::: :::::::.. ........._.!_... <br /> :!::::::::::::::: ::!!:::: :::!::::::::::::::::::::::::::::::::::_,-_:............:::::::::::::.............................................................. RELI:CVf_D BY DATE RACE LVED !m <br /> ..............::�:::::::::. .. <br /> ! $...EEP5 #.... COMPUTER # LOG` CO6E .......DISI' LODE AMWN( RECEIVED CHECI( #/CAS .;; <br /> m <br /> !RRc!![[[:t!!5!:::_E!!!!!::!:![!i:::--:a::::::::::::.......:........._:__._.—. <br /> EH 23 032 (REVISED 10-28-93) Page 11 <br />