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S1Rr XACUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE 'JCRKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> A Stockton Metropotitan Transit District John W. Stewart <br /> C <br /> I FACILITY ADDRESS SITE PHONE .1 with AREA CODE <br /> L 1533 East Lindsay Street ( 209) 948-5566 <br /> 1 <br /> T CITY STATE ZIP CODE S of TANKS <br /> Y Stockton Ca . 95205 at SITE 6 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P Walton Engineering Inc . Mike Lee <br /> 'I MAILING ADDRESS APPLICANT PHONE I WITH AREA CODE <br /> C 837 Riske Lane ( 916 ) 372-1888 <br /> A <br /> N CITYSTATE ZIP CODE <br /> TYPE of APPLICATION new <br /> T West Sacramento Ca . 95691 CLOSURE, INSTALLATION, ace. installati n <br /> TOTAL <br /> A <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 <br /> I S <br /> V <br /> TANK FEE = S50.00/TANK (prior to Jarn:ary 1,1991) 5170/TANK (after January 1, 1991) <br /> F 9 Tanks = r <br /> 6 1987 11988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply f byfee for <br /> C each year applicable) $ <br /> T <br /> L STATE SLRC)UAGE - S56.00 each TANK (Due every 5 years) See California H d S Code, Section 25287 <br /> I <br /> T d Tanks z $56.00 1986 through 1990 1991 through 1996 <br /> Y (enter amou+[ and year) <br /> S <br /> PERMANENT CLOSURE (Removal or Authorized Ctosure-in-Place) TANK I.D. :(s) <br /> C <br /> L CLOSURE FEE - S53.00 per hour (3 hours minimum per TANK) I if TANK(s)_ X $159.00 5 <br /> 0 <br /> S <br /> U TEMPCRARY CLOSURE (A one-time permit, for review d inspections TANK I.D. :(S) <br /> R <br /> E TEMPORARY CLOSURE FEE - $150.00 each TANK P TANK(s) X $150.00 = S <br /> P PLAN CHECK (Install. Plan Review d Construction Inspections) TANK LD. 1(s) <br /> L <br /> A \) <br /> H PLAN CHECK FEE - S53.00 per hour (8 hours minimum per Facility) = S426.00 mini mm S (f2(,� ��Lv <br /> R REPAIR TANK 1.0. Y(s) / <br /> S <br /> P TANK REPAIR FEE = S53.00 per hour (3 hours minimum/TANK) R TANX(s) _ X 5159.00 = S <br /> A <br /> 1 <br /> R PIPING REPAIR REVIEW d CONSTRUCTION = S53.00 per hour 0 hour minimum per facility = $159.00) S <br /> M CONSULTATIONS UNAUTHCRIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> S <br /> C FEE = S53.00/hr FEE 553.00/hr FEE S 53.00/hr <br /> TOTAL DUE S 2 <br /> OFFICE USE ONLY <br /> i a:'�75�' " `-'C'OC CCDE�� 1151 CODE iWIC <br /> UNiC.0"0Y•`rC rY /C�Sri-"t �YC`i0dY" cITiE� <br /> Is <br /> �a=oRro(i Oat=R�2•�`Y r^S M'3>X�-'.x G':T.^..� �Q'—^tm3�WY DR�mY,"..�"�"w':S`.':Y:�.'.^..Y�:Y:`.,YY,„JLi�Yt�J VY��fva Yfe=oAartOiiir'M�i <br /> , f <br />