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SAN JOAQU I N LOCAL. HEALTH DISTRICT <br />,...,JERGROUND STORAGE TANK PR06RAM - FEE WORKSHEt;, <br />F <br />FACILITY/SITE NAME <br />FACILITY CONTACT NAME <br />A <br />C <br />Lodi Ready Mix <br />Bob Spoor <br />I <br />L <br />STREET ADDRESS 851 E. Lodi Ave. <br />SITE PHONE 1 (with Area Code)(209) 368-2794 <br />i <br />T <br />one hour to be paid on plan submittal) <br />$ <br />V <br />E TANK FEE = $50.00 each TANK <br />F 1 Tanksr $50.00 <br />A (multiply_ 1 by fee for <br />C each year applicable) <br />Y <br />CITY Lodi <br />STATE <br />IIP CODE <br />1 of TANK'S <br />FEE = $35.00/hr <br />CA <br />95240 <br />at Site 2 <br />A <br />APPLICANT/BILLINGME <br />APPLICANT CONTACT NAME <br />P <br />Lodi Ready Mix <br />Bob Spoor <br />P <br />1989 <br />L <br />I <br />MAILING ADDRESS 851 E. Lodi Ave. <br />APPLICANT PHONE 1 (with Area Code) <br />$ <br />(209) 368-2794 <br />A <br />N <br />CITY Lodi <br />STATE <br />ZIP CODE <br />TYPE of APPLICATION Tank <br />T <br />I <br />CA <br />95240 <br />(Closure, Installation, etc.) Removal <br />FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR <br />TOTAL <br />A <br />C <br />T <br />I <br />1986 <br />1997 <br />1988 <br />1989 <br />f <br />N PLAN CHECK FEE = $30.00 each SUBMISSION/RESUBMISSION <br />$ <br />A <br />I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum <br />one hour to be paid on plan submittal) <br />$ <br />V <br />E TANK FEE = $50.00 each TANK <br />F 1 Tanksr $50.00 <br />A (multiply_ 1 by fee for <br />C each year applicable) <br />1986 <br />1987 <br />1988 <br />1989 <br />FEE = $35.00/hr <br />FEE _ $35.00/hr <br />f <br />f <br />I <br />L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH 6 SAFETY CODE Sec 25281 for applicability) <br />I <br />T 1 Tanks x $56.00 <br />Y (enter awount and year) <br />1986 <br />1987 <br />1988 <br />1989 <br />$ <br />C PERMANENT CLOSURE (Removal or Closure -in-place) <br />L <br />0 CLOSURE FEE = $90.00 each TANK <br />t Tanks_2__ x $90.00 f 180.00 <br />S — <br />U <br />R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br />E <br />TEMPORARY CLOSURE FEE = $80.00 each TANK <br />1 Tanks X $80.00 f <br />P PLAN CHECK (Installation or Repair) <br />— <br />L <br />A <br />f <br />N PLAN CHECK FEE = $30.00 each SUBMISSION/RESUBMISSION <br />$ <br />REPAIR <br />F. <br />E TANK REPAIR. FEE = $110.00 each TANK <br />1 Tanks x $110.00 <br />f <br />A <br />I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum <br />one hour to be paid on plan submittal) <br />R <br />UNAUTHORIZED RELEASE EVALUATION <br />(when applicable) <br />CONSTRUCTION <br />INSPECTION <br />SAMPLING <br />INSPECTION <br />FEE = $30.00/hr <br />FEE = $35.00/hr <br />FEE _ $35.00/hr <br />f <br />TOTAL DUE <br />f <br />OFFICE USE ONLY <br />E <br />1 COMP 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK WASH RCVD BY DATE RECEIVED PERMIT 1 <br />EH 13 UJ2 1[i8o <br />