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A-06-1998 9-01AM FRIT SACRAMENTO 916 635 2606 P. 16 <br /> SAM iDRa11 PIALIC HEALTH SERVICES - p91HON1MAL OIYSIOI <br /> ' UgpERSsD= SSORAi£ TM K PROEAAII - FEE WORKSiISET <br /> S FACILITY SITE NAME FACILITYTAC7 MANE ( <br /> S l5 C ICISCCJ <br /> E FACILITY ADDRESS SITE. PRIM 3 with AREA OSOE <br /> z <br /> 3 {>AC rFrc A <br /> :51tc I<- <br /> CITY <br /> sCIT7 SPATE ZIP (xbE A of TAW6 <br /> at SITE <br /> A CSC GnJ <br /> P APPLICANT CONTACT RAKE <br /> P APPLICAMTl81 LLIND NAME <br /> �j14�lU�Tf- <br /> I API MT PHONE WITH AREA CSE <br /> C MAILING ADDRESS ,1 <br /> " 2c`•'� UN (5C G_vP ' tioG 4Y(a 3.�^ �^1'a NSTATE ZIP (DOE <br /> � [GT(DM <br /> CITY � -7 7j <br /> ANC�O Q�aA +^g ^� (Ctosurc Installation, etc-) <br /> TOTAL <br /> Ii1986 1197 1968 1989 1990 <br /> I ANNUAL FACILITY FEE (Prier to January 1, 1991) _ 5100.00 MR =K1fs10( xxxx xxxx S X=00=All <br /> C xxxx MIX )0= XXx1( xxxx s XX)D xx <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable} <br /> I1, 1441) <br /> V TANK FEE - S50.00ITAAc (Prior to Jana " 1,;991) 51701TANK (After January <br /> E 1987 1488 198914M t991 1992 1443 ! 1494 ;995 1946 ]997 <br /> # Tanks = , <br /> F (mutopty X by fee far 1 S <br /> A eacb Year applicahie) xxxx xxxx 10001 mm X== { <br /> I TANK PENALTY FEES ASSESSED I xxxx xxxx f )COIX x70gi xxxx l 5 <br /> L t5 <br /> 1 STATE SURCHARGE FOR NEW FACILITIES ONLY ; $18-50 <br /> T 1991 through 1996 (656) 1997 <br /> Y # T&&I z 28.00 1988 thrgueii 1990 (5561 { <br /> SURCHARGE FOR 1997 )Ol ouncxxxx%x)000000(NxX}I%cc xXxx =x7CfJ09f%X7DP01= J S <br /> C DERNIINEHT Ct9521RE (Remloval'ar Autnorized Closure•in-place) TANK 1.0_ ills) <br /> L # TA1{KCS}_ % 2234.00 v S <br /> DI cit>SI1RE fEe = S78.00Mour ($ hours miniaFAyTANK) <br /> S TANK I.0. 4(s) <br /> U TEMPI CLOSURE (Plan Reviews & Irmper:tlons) <br /> R § <br /> E [FNp11RARY CLOSURE FEE = 578.OD/hour (3 hours miniFWFACILITY) 5234_O0 minim <br /> P INSTALLATIGN PLAN CRECK (Plan 2�VieM s Cermtrnction IMPectienI TANK t.0. N(s) <br /> L <br /> F g <br /> N PIAN (])EI7, FEE = $78.00/haur (8 hours nimmOaVFACILITY) 5624.00 minimum <br /> R REPAIR FEE (Workplan Review L Construction Inspections) <br /> E <br /> P TANK LINING REPAIR FEE = SM-00Jha+r (3 hours mininaNTANK) ? TAMK{s) x 5234.00 = S <br /> A 2 <br /> I TANK RETROFIT REPAIR FTE = 571l.30/hcur (3 hours min./FACILITY) w 5234.06 ni^imm <br /> R 5 <br /> PIPING REPAIR FEE = S78.O01hour (S hours ®irtimwa/fAC1Liri) . s234,01) nrinimw <br /> rCtIMSU FEE = 520.00UNAUTRORIZED RELEASE EVALUATS <br /> . s78_00/hrTTCN FEE = 578.00/hr S}WP1.IN£ imsPECTIDN FEE 5 <br /> TOTAL OLE s <br /> FU( OFFICE USE OILY <br /> SWEEPS N COMPUTER # l LDC CODE NIST i[OE I ANDUsT RELIVED CHECK a/CASX I RECEIVED BY OATE RECEIVED 3 <br /> EN 23 OM (REVISED S-Z7-97) <br />