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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICE' <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE VCRK7--�cET <br /> FACILITY SITE NAME FACILITY CONTACT NAME RE 'VE <br /> F .American Moulding & Mill-works Co. Uarvin Palmer APRCID <br /> 1 FACILITY ADDRESSSITE PHONE # with AREA JOAQUIN COUNTY <br /> ' 1 1811 Marshall Avenue, X80 � (�2Sf��" 209 946- LIC HEALTH SwF <br /> _ ISTATE ZIP CODE 0 of }a111i1K LIH DIVFSFloI <br /> Y OStockton, I CA 95205 1 at SITE 80 feet ob pipe <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P DAMS & 1IMPE, - Representing Amer. Forest Jeffrey Sold <br /> L Products CO- <br /> 1 MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> D 9300 Tech Center Drive Suite 100 (916)364-8698 <br /> A <br /> N CITY STATE ZIP CODE TYPE of APPLICATION Closure <br /> — T Sacramento CA 95326 CLOSURE, INSTALLATION, etc. <br /> 7 <br /> _ e <br /> TOTAL <br /> q <br /> — C 1986 1987 1968 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = 2100.00 <br /> 1 1 _— <br /> V <br /> E TANK FEE = 550.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> 1 <br /> .._ F 0 Tanks = 1986 1 1987 1988 1989 1990 1991 1992 1993 1994 1 1995 1 1996 <br /> A (multiply k byby fee for <br /> C each year applicab(e) S -- <br /> _ 1 <br /> L STATE SURCHARGE = 156.00 each TANK (Due every 5 years) See California H d S Code, Section 25287 <br /> J i <br /> T # Tanks x 156.00 19% through 1990 1991 through 1996 <br /> Y (enter amount and year) <br /> PERMANENT CLOSURE (Removal or Authorized Clcsure-in-Piece) 'j7 ANK I.D. #(s) <br /> — C <br /> L CLOSURE FEE = 153.00 per hour (3 hours minimum per TANK) A TANK(s)_ X 1159.00 1 __ <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE - 1150.00 each TANK # TANK(s) _ X 1150.00 <br /> P PUN CHECK (Install. Plan Review 6 Construction Inspections) TANK I.D. #(s) <br /> L [y <br /> Am _ . <br /> N PUN CHECK FEE - 553.00 per hour (8 hours minimper Facility) = 1424.00 minimum S <br /> F <br /> R REPAIR FEE (workplan review b construction inspections) TANK I.D. #(s) <br /> E <br /> P TANK REPAIR FEE = 153.00 per hour (3 hours miniax VTANK) # TANK(s) X 1159.00 = 1 -- <br /> A <br /> I <br /> R PIPING REPAIR FEE = 153.00 per hour (3 hour minimzn per facility = 1159.00) 1 -- <br /> PCF <br /> TAT IONS ReVieW Of UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION SOil <br /> -' lication aTnpling underneath pine <br /> S <br /> —. S53.00/hr c FEE 553.00/hr FEE = B 53.00/hr 253• 106 . 00 <br /> TOTAL DUE 1 106 . 00 I <br /> OFFICE USE ONLY <br /> i„isi arais�wasww aw wiww_ar aiw.aww wrarr uiaia r w siw railaaiafrFr r ar rw�rw i raawrrrrar_r rrrr <br /> .� EN 23 032 (REV 1/10/91) ft Pace 11 <br /> NOW �� <br />