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SAN JOAQUIN 03" PUBLIC HEALTH SERVICES - ENVIRONMENTAL HIM DIVSION <br /> UNJIFRn_lu_n STORAGE TANK PROGRAM - FEE YORKSHEE <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> 1 <br /> T Bobcat Central Lou Franzia <br /> E FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> & 1113 N . Shaw Road <br /> CITY STATE ZIP CODE # of TANKS <br /> A Stockton CA 95205 at SITE 3 <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L Oil Equipment Service Keith A . Tallia <br /> I <br /> CMAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> A P . O . Box 950 209-754-1808 <br /> N <br /> T CITY STATE ZIP CODE I TYPE of APPLICATION <br /> San Andreas CA 95249 (Closure, Installation gte�a de <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br /> A f <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) )OXX XXXX <br /> I <br /> V TANK FEE = 550.00/TANK (Prior to January 1,1991) 5170/TANK (After Ja uory 1, 1991) <br /> E <br /> # Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F (multiply # by fee for <br /> A each year applicable) <br /> C <br /> I TANK PENALTY FEES ASSESSED XXXX XXXX S <br /> L <br /> I STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 <br /> T <br /> Y # Tanks z $56.00 1986 through 1990 1991 through 1996 <br /> (Enter amount and year) <br /> S <br /> C PERMANENT CLOSURE (Removal or Authorized CLosure-in-Place) TANK I.D. #(s) <br /> L <br /> O CLOSURE FEE = 578.00/hour (3 hours miniM m/TANK) # TANK(s) X $234.00 - E <br /> S <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X 5234.00 = S <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = S78.00/hour (8 hours minimum/FACILITY) $624.00 minimum S <br /> R REPAIR FEE (Workplan Review & Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) _ X 5234.00 = <br /> A <br /> I TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) = $234.00 minimum <br /> R <br /> PIPING REPAIR FEE = S78.00/hour (3 hours minimum/FACILITY) = $234.00 minimum s <br /> M TRANSFER FEE = 820.00 UNAUTHORIZED RELEASE EVALUATION - 578.00/hr <br /> I <br /> 5 <br /> C CONSULTATION FEE = $78.00/hr SAMPLING INSPECTION FEE = S78.00/hr <br /> TOTAL DUE <br /> FOR OFFICE USE ONLY <br /> SWEEPS # COMPUTER # LOC CODE DIST CODE AMOUNT RECEIVED CHECK #/CASH RECEIVED BY DATE RECEIVED a <br /> 3 <br /> S <br /> 3 <br /> 3 <br />