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4 JOAOLIIN COUNTY PUBLIC HEALTH SERVICES r <br /> ENVIRONMENTAL HEALIN DIVISION <br /> UND ROUND STORAGE TANK PROGRAM FEE tJORKSHEET <br /> + I <br /> FACILITY CONTACT NAME <br /> FACILITY SITE NAME' <br /> FRo er Scri�en f <br /> A Pat lella''Truck irlg Inc. 4 <br /> C SITE PHONE p with AREA CODE <br /> 1 FACILITY ADDRESS „ ��� <br /> L '2150 B. Fremont St I <br /> t STATE ;ZIP CODE 0 of TANKS I <br /> T CITY at SITE <br /> 2 <br /> Y Stockton, � Ca. 9521 � <br /> APPLICANT CONTACT NAME <br /> A APPLICANT/BILLING NAHE <br /> P Roger Scri�en . <br /> P Parlella Trucking, Inc. ,I <br /> L APPLICANT PHCNE.M LATH AREA CODE <br /> I HAILING ADDRESS (209)943-5000 f <br /> C 5000 E. Fremont SM.. <br /> A STAfE �P2sE TYPE of APPLICATION <br /> N CITY Stockton, a. I CLOSURE, INSTALLATION, ttc. Removal. <br /> i <br /> —� — _— TOTAL <br /> A 1986 1987 1988 19;89 1940 <br /> C <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = f100:00 $ <br /> I <br /> E TANK FEE - 150i00/LANK (prior to Jarxrary 1,1991) . <br /> 1170/TANK (after January 4� 1991) <br /> = 1986 1987 1988 1969 1990 1991 1992 1993 1994 1995 1996 <br /> F N Tanks <br /> A (a,fltiply A by fee for ! <br /> C each year Appticobte) <br /> L STATE SURCHARGE = 1'156.00 each TANK (Due every 5 years) See Catifcrnia H R S Code, Section 2x5287 i <br /> I1991 through 1996 <br /> I t Tanks x 15b.00 1986 through 1990 !i <br /> Y (enter amount and year) f <br /> r I <br /> I <br /> PERMANENT CLOSURE (Remove! or Authorized Ctosure-in-Place) TANK 1.D. N(s) <br /> r.L CLOSURE FEE = 153.00 per hour (3 hours,lminimm per TANK) N TANK(s) 2 _ X $159.00 In s 3 X8.40 <br /> 0 <br /> S a <br /> U TFHPORARY CLOSIIRF. (A one-time permit, for review/inspections? TANK I.D. d(s)_ <br /> R ti 0 TANK(s) X $150.00;..= f <br /> E tFMPCRARY CLOSURE FEE = 1150.00 each TANK <br /> I Y <br /> P PLAN CHECK (Irtstat(. Ptan Review d Construction7inspecti0nW' TANK I.Q. If(s) <br /> L <br /> AS <br /> N PLAN CIIECK FEE 153.00 per hour (8 hours minln,<nt per Facility) - 3424.00 mininAin <br /> ----------------- <br /> rA <br /> rREPAtRorkpian review !< construction inspections) =D #EE = 153.00 per hour (3 hours minimrmlTANK) $159.00 $ <br /> PIPING REPR FEE = 153.00 per Hour (3 hour minimtm per facility = $159.00) <br /> M CONSULTATIONS UNAUIHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> EI , <br /> S FEE = 1 53.00/hr <br /> C FEE 553.00/hr FEE 153.00/hr <br /> TOTAL DUE <br /> .......w.O.S�r.yLF.J.wEF...EIr�.C}.eg.E.Sy»..�e.wUSE <br /> .»..».O.w..N«.L.w.Y <br /> .�.....«..»..�..r.......a. r�...�....�...n. .... <br /> LI1kl I A/[AS11 <br /> ...w..w..e...w..�.... <br /> .......... <br /> iiin ...... <br /> »y »w ....�:.i....�....�.....�.... <br /> WrammrWAWNS <br /> n.l;... �[���[ xW »li <br /> IF <br /> rQ t e. <br /> » 1 ] - <br /> .:.. . ......fir.......... .. maw AW AW l WN NM WMAAN AWN AW ow <br /> J �7Q ......�Z..... ........... .... .....r.. AMA$lYw ApAMr <br /> /./l••••••�•.•••••..iwi MrN 'iii�»«M rx we..�wn we.�nn»aw w..n.s ..r.rr..w rw s.:n�.i iii.w...»a wn.ne.NW*JWneee�w.ne. 11M AMw <br /> nes>.es r+.q Mas le.us <br /> MDA ON fe'�elr ARK PAW!SN tow AMY AMI AWW ASK ffm AMY AVMY AIX lRMOf AOA ffRf H10K lreY AMIMr AMM/NRA AreK AIN AMIMH AaM AAAKf AMY AAtltlM AnK AMMIf AAK AIX ArodlK AMrt AM1w Jrw . <br /> Paae 1 1 <br /> EN 23 032 (REV 1/10/9111 ft "�' <br />