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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> F FACILITY/SITE NAME Santa Fe Railway Co. FACILITY CONTACT NAME <br /> `� Stockton Fueling Facility Dave Erwin <br /> 1 <br /> L STPEET ADDRESS SITE PHONE 1 WITH ARCA tout 209/942_5450 <br /> 1 Diamond Street <br /> T <br /> Y CITY STAT IIP CODE I I of Tanks <br /> Stockton I CA 95205 at Site 3 <br /> A APPLICANTIBILLING NAME APPLICANT CONTACT NAME <br /> P Environmental Solutions, Inc. Tim Lassen <br /> L <br /> I KAILING ADOPESS 21 Technology Drive APPLICANT PHONE I "'r" "A "99 714/727-9336 <br /> C <br /> A <br /> N CITY !CIA <br /> IIP CODE TYPE of APPLICATION Tank <br /> I Irvine 927X$ GL0*UAc. i"OrALa..reu". rrc. Removal <br /> AFACILITY FEE = $100.00 each SITE ADDPESS per YEAR TOTAL <br /> 89 <br /> - <br /> T 1986 1987 1988 11 <br /> I t <br /> V <br /> E TANK FEE _ $50.00 each TANk <br /> FTanks x $50.00 1986 1987 1988 1889 <br /> A (multiply-t-by fee for <br /> [ each year applicable) t <br /> STATE SURCHARGE = $56.00 each TANK (see CA HEALTH i SAFETY CODE Sec 25287 for applicability) <br /> T 1 Tanks_ _ _ x $56.00 1986 1987 1988 1483 <br /> Y (enter mount and year) <br /> t <br /> L PERIIAI(EMT CLOSURE (Removal or Closure-in-place) <br /> 0 CLOSURE FEE = $90.00 each TANK <br /> S 1 Tanks____ x $90.00 t 270.00 <br /> U <br /> nE <br /> Y CLOSURE (Only allowed one time for up to two years) <br /> TEMPORARY CLOSUP.E FEE : $80.00 each TANK I Tanks x $80.00 $ <br /> P PLAN CHECK (InstallatLon or Repair) <br /> L <br /> A <br /> N PLAIT CHECK FEE _ $30.00 each SUGHISSION/RESUBMISSION $ <br /> REPAIR <br /> R TANK REPAIR FEE _ $110.00 each TANK II Tasks x $110.00 $ <br /> E <br /> P <br /> 1 PIPINS REPAIRICLOSUREIREMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING IIISPECTION <br /> (when applicable) (when applicable) (when applicable) <br /> ,FEE - s30.001hr FEE = $35.00/hr FEE = $35.001hr t <br /> TOTAL DUE Is <br /> OFFICE OSE ONLY <br /> LSU;;kEEPS COUP I LOC CODE DIST CODE AMOUNT DUE AMOUNT P.CVD :CHECK WASH $;CVD BY DATE PECE1VfD PEPMIT e <br />