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11-17-1999 3:40PtI FFCL1 P 3 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVSION <br /> UNOERGROl1ND STORAGE TANK PPAgRkM - FEE WORKSHEET <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> I MASON CENTER FRED PAKZAD <br /> T <br /> 'E FACILITY ADDRESS SITE PNOME # with AREA 4174E <br /> 6425 PACIFIC AVE <br /> a <br /> C17Y STATE IIP CODE a of YANKS <br /> A STOCKTON CA 95207 at Si TE 3 <br /> P <br /> P APPLICANT/BiLLiNG NAME APPLICANT CONTACT NAME <br /> L W.A. CRAIG INC LELAND YIALELIS <br /> I <br /> C NAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> A 6940 TREMONT RD 707-693-2929 <br /> x <br /> T CITY STATE ZIP CODE I TYPE of APPLICATION INSTALLATION <br /> DIXON CA 95620 (6tosure, Installation, erc.) <br /> TOTAL <br /> 1 1986 1987 1985 T989 T990 <br /> ANNUAL FACILITY PEE (Prior to January 1, IQQI) = 9100.00 <br /> A XXXX XXXX I XXXX 1 XXXX XX%X S XXXXXXXX <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If AppLicabLe) XXKX XXXX XIX% XXXX XXXX 5 XXXXXXXX <br /> V TANK FEE = S50.00/TANK (Prior to JanUary 1,1991) 5170/TANK (After January 1, 1991) <br /> 9 Tanks = 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 <br /> F (multiply k byby fee for <br /> A each year mpp0 cabLe) XXXX %XXX XXXX %%%X %XXX S <br /> C <br /> L, <br /> TANK PENALTY FEES ASSESSED XKXX XXXX XXXX XXXX XXXX S <br /> L <br /> Y STATE SURCHARGE FOR NEW FACILITIES ONLY-SIS.SO S <br /> Y <br /> Yl # Tanks_ X 58.00 1988 through 1993 ($56) 1993 through 1997 (956) 1998 <br /> I SURCHARGE FOR 1998 XXXXXXXXXXXXXXXXXXXXXXXXXXX )OIXxxxxxxxXXX%XXXXXXXXX S <br /> I <br /> C� PERMANENT CLOSURE (Removal or Authorized Closure-in-PLace) TANK 1-0- #(5) <br /> O CLOSURE FEE = %78.00/nour (3 flours mini=m/TANK) # TANK(g) % S234.00 S <br /> S <br /> U TEMPORARY CLOSURE (Plan Review & Inspectiam) TANK I.O. #(S) <br /> R <br /> E TEMPORARY CLOSURE FEE = 578.00/hour 43 hours mininWFACILITY) 9234.40 minimum S <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> x PLAN CHECK FEE = 578.00/hour (8 hours minimum/FACILITY) = S624.00 minin". S <br /> RI REPAIR FEE (Workplan Review & Comtructi0n Inspections) TANK I.D. #(s) <br /> E <br /> PI TANK LINING REPAIR FEE = %78.00lhour t3 hours minimum/TANK) # TANK(S) _ X 5254.90 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) m 5234.00 minimum $ <br /> R <br /> PIPING REPAIR FEE S78.00/hour (3 flours mirtinnAn/FACYLITY) 9234.00 minimum S <br /> M TRANSFER FEE = 320-DO UNAUTHORIZED RELEASE EVALUATION � S78.00lhr 9 <br /> I I <br /> S <br /> C CONSULTATION FEE = S78.00/hr XX SAMPLING INSPECTION FEE = $78.00/hr $ <br /> TOTAL DUE 9 <br /> FOR OFFICE USE ONi. LY <br /> : :::..;- ............... :_.. .. :� ..I�. �::�-:::� .�1 IILI III I .... <br /> ._..—_.............:._..._...�::=_.:sy...:::......: _:,:.u:...::: wLis:u:w ::Asa:-=:c-_::_^r-�:--:=;:;.�;:s;::;:_::__snur.::niN:milnnin� ImmnnnUunuTiunauu:+s:ai <br /> 1� SWEEPS # I COMPUTER B LOC CODE DIST CODE AMOUNT RECEIVED , CMECK #ICASN RECEIVED BY BATE RECEIVED <br /> `I <br /> n I <br /> ::....__..........._..._....._1_....._...._._....._...._.1::— .._.___..........._ ...$. r: law: :,:,::m,.:::::::::::_�:::-::::::-::::.�;:�r; _ --:r �s�alc::m:r.,y::::,:,::,�; _:.I.,,: <br /> _. _ spy` <br /> FH 7't n42 IRPV15Fn 1-.P-9Ai <br />