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SAN JOAQUIN 0OURTY IC HEALTH SERVICES - ENVIRONMENTAL HEALTH n'"SION <br /> UNDERGR STMAGE TANK PROGRAM - FEE WORKSHEET <br /> rCAM <br /> E NAME FACILITY CONTACT NAME <br /> The Port of Stockton Aldo Fre ai <br /> SITE PHONE 9 with AREA CODE <br /> RESS 2201 W. Washington St. (209)946-0246 <br /> STATE ZIP CODE ti of-TANKS <br /> at SITE 1 <br /> Stockton, CA 95203 <br /> ILLING NAME APPLICANT CONTACT NAME <br /> The Port of-Stockton Same as above <br /> RESS APPLICANT PHONE 0 WITH AREA CODE <br /> P.O. Box 2089 - (209)946-0246STATE ZIP CODE TYPE of APPLICATION(Closure, Installation, etc.) Removal <br /> Stocktoni. CA 95213 <br /> TOTAL <br /> If 14$6 1987 1988 1989 1990 <br /> r ANNUAL FACILITY FEE (Prior to January 1, 1991) = S100.00 9 <br /> A <br /> fC XXXX XXXX S <br /> i° FACILITY PENALTY FEES ASSESSED (If Applicable) <br /> TANK FEE = 550.00/TANK (Prior to January %Ml) 5170/TANK (After January 1,. 1991) <br /> E <br /> -- 0 Tanks 1986 1987 1988 1984 1990 1991 1992 1993 1994 1995 1996 <br /> (multiply it by fee for -- <br /> am <br /> S <br /> each year applicable) <br /> C S <br /> -i TANK PENALTY FEES ASSESSED XXXX XXXX <br /> I STATE SURCHARGE _ $56.00 each TANK (Due every 5 years) See California N & S Code, Section 25287 <br /> Y # Tanks x 956.00 1985 through 1990 1991 through 1995 <br /> (Enter amount and year) $ <br /> -.0 PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. 0(s) <br /> L s TANK{s} 1 X 5234.00 = s 234.00 <br /> a CLOSURE FEE = S78.00/hour (3 hours minimu�/TANK) <br /> S <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. 0(s) <br /> R = S <br /> E TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) 0 TANK(s) X $234.00 <br /> _P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK 1.0. 9(s) <br /> L <br /> A <br /> N PLAN CHECK' FEE a S78.'00/hour (8 hours minimum/FACILITY) = 5624.00 minimum = <br /> R REPAIR FEE (workplan Review & Construction Inspections) TANK I.D. $(s) <br /> _ E ' <br /> P TANK LINING REPAIR FEE = S78.00/hour (3 hours minimum/TANK) TANK(s) X 5234.00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE a 578.00/hour (3 hours min./FACILITY) = $234.00 minimus S <br /> R <br /> PIPING REPAIR FEE = $78.00/hour (3 hours minimum/FACILITY) 5234.00 minimum S <br /> ry M TRANSFER FEE a S20.00 UNAUTHORIZED RELEASE EVALUATION = $78.00/hr s <br /> - 1 <br /> S <br /> C CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE = S78.00/hr : <br /> LTOTAL DUE s234.00 <br /> FOR OFFICE USE ONLY <br /> --._.._._...-. .. •-•- __::::�._.__._-____..:�:.:._r�._r_.._:mss=z_._:w..:_�:....-"-_—=-._._._1--:_::..:.._-.�:• ==—T=._._.::�...=- ._- _ <br /> .:.s._........».._ �_.�...«...:A.-.._ ___TJX—.=1f�••-=-__—_ ._...i ..-�.. p^•^•[i••_ <br /> SWEEPS # COMPUTER 0 - LOC CODE DIST CODE AMOUNT RECEIVED CNEC /CASH RECEIVED BY DATE RECEIVED EllE <br /> 5 //93 - 53 3 <br /> H 23 032 (REVISED 11-1-92) Page 11 <br />