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SAN , -1,QU1N COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - EEE WORK MEET <br /> F <br /> I <br /> ' i FACILITY SITE NAME FACILITY CONTACT NAME <br /> Tri Star Homes, LLC Kelly Thore <br /> T SITE PHONE N with AREA CODE <br /> E FACILITY ADDRESS 1325 N. Corral Hallow Rd, NZA <br /> a STATE ZIP CODS N of TANKS <br /> CITY at SITE <br /> v A Trac . <br /> P APPLICANT/BILLING NAME Tri ,Star Homes, LLC APPLICANT CONTACT NAME Kelly Thorpe <br /> i <br /> MAILING ADDRESS APPLICANT P40HE N WITH ARE/��289Q``��))1839_2890 <br /> P.O. Box 1056 t <br /> �N ' STATE ZIP COOL: TYPE of APPLICATION <br /> T CITY Alamo, CA 945D7 (Closure, installation, etc.) Removal <br /> F TOTAL <br /> l <br /> A TANK FEE = %50.00/TANK (Prior to January 1,1441) 5170/TANK {After January 1, 1991) <br /> T N Tanks = 1986 1487 1988 1489 1940 14911 1992 1993 1994 1995 1996 <br /> 1 (muttiply Y-15yfor I S <br /> V each year app(Icab(e) XXX% %XXX <br /> %X%% XXX% %%XX <br /> E : <br /> TANK PENALTY FEES ASSESSED %XXX XXX% XXX% %XX% XXX% <br /> 5 <br /> 1 STATE SURCHARGE a 556.00 each TANK (Due every 5 years) See Catiforrila N A S Code, Section 2528 <br /> T 1986 through 9990 I 1491 through 1496 <br /> E N Tanks X $56.00 <br /> (Enter amount and year) X X <br /> I <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK i I.D. N(s) <br /> 0 CLOSURE FEE - $78.00/hour (3 hours minimum/TANK) N TANK(9) 2 — X =234•00 ' s4 68.00 <br /> S TANK I.D. N(s) <br /> U TEMPORARY CLOSURE (Plan Review Ii Inspections) <br /> s 11 <br /> E TEMPORARY CLOSURE FEE = $78.00/hour 0 hours minimum/FACILITY) 5234.00 minimum s <br /> *- I <br /> rt <br /> INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANKSI.D. N(s) <br /> s <br /> PLAN CHECK FEE = S78.00/hour (8 hours minimum/FACILITY) %624.00 minimum <br /> r <br /> R REPAIR FEE (Workplan Review Z: Construction Inspections) TANK I.D. N(s) <br /> P TANK LINING REPAIR FEE _ 978.00/hour (3 hours minimum/TANK) N iAiHK(s) X !234.00 a E A <br /> �f TANK RETROFIT REPAIR FEE = 178.00/hour (3 hours min./FACILITY) = 5234.00 minilltum <br /> R = 1,'234.00 minimumE <br /> PIPING REPAIR FEE _ %78.00/hour (3 hours minimum/FACILITY) <br /> I <br /> „ TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION ei %78.00/hr >1 <br /> I <br /> S - f <br /> C CONSULTATION FEE = f78.00/hr SAMPLING INSPECTION FEE _ %78.00/hr <br /> `. TOTAL PULE ' <br /> I-ApVU <br /> U <br /> Ft !, <br /> lI UN Mo. 'yc!!:o,,ym.Ill:m u„Ellvanin!lt�n.�7gCFFm'6Q �1:II�IHm!sg�± �gy y! p .Ity, e <br /> !•,n... EES!;g!,r;!I! :ni !i. "•I+COC Ct7D :!r.;nn!i: _ .9.i . !:..E ' 'REyCIV! � � AS . <br /> A <br /> RM.INV I <br /> �ptt�;i!nnrnnnun!!nnllm.unnutrugimm�mmlmea.:ry�g�_.nlr ann .manleea <br /> I?I!:!^:t?i?i:i!!:ii!E!iii!rig!41iii:ihFEE!ii!l::i!:!:::I�iiiiieTis..lie!;,nu:.!I:nfcr.!gemr.!5i9P.r_, aupmL^ir _ anlee.9rta{oi�r9�-t!nYn'm!'fr!rt!!Le �!!Lm!!!RII!t�!�pn�, Y sn I_ <br /> F <br /> I <br /> N 23 046 (Revised 9/11/96) Page 11 <br /> Fr <br />