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UNDERGROUND STORAGE TANK PROGRAM - FEE 410RKSHEET <br /> FA <br /> ITE NAME FACILITY OOH TACT N�IE <br /> Concrete Inc. David Barna <br /> DDRESS SITE PHONE iF with AREA CODE <br /> 749 S. Stanislaus St. (209) 983-6565 <br /> CITY STATE IZIP CODE R of TANKS <br /> StOCkton, CA 95206 at SiTE <br /> APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> FL Same as above David Barney <br /> 1 MAILING ADDRESS APPLICANT PHONE IR WITH AREA CODE <br /> L P.O. Box 66001 <br /> H � <br /> T CITY STkTE 21P CCORemoval <br /> E TYPE of APPLICATION <br /> StOCkton, CH 95206 (Closure, instatletlon, etc.) <br /> TOTAL <br /> 1986 1987 1 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) _ ;100.00 <br /> C <br /> s <br /> 1 FACILITY PENALTY FEES ASSESSED (If Appticable) XXXX XXXX f <br /> TANK FEE 150.00/TANK (Prior to January 1,1991) 5170/TANK (After January i, 1991) <br /> H Tanks 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> nL <br /> (multiply a sEy fee for <br /> each year applicable) <br /> ; <br /> IA14K PENALTY FEES ASSESSED XXXX XXXX ; <br /> L i <br /> LSTATE SURCHARGE = 556.00 each TANK (Due every 5 years) See California H A S Code, Section 25287 <br /> I Tanks x 256.00 1985 through 1990 1991 through 1996 <br /> (Enter amount and year) <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Plece) TANK F.O. I1(s) <br /> L <br /> CLOSURE FEE v !78.00/hour (3 hours minlmum/TANK) N TANK(s) 2 X 3234.00 ■ $468.00 <br /> TEMPORARY CLOSURE (Plan Review b Inspections) TANK I.D. li(s) <br /> I <br /> R <br /> FF TEMPORARY CLOSURE FEE _ !78.00/hour 0 hours minimum/FACIEITY) _ =234.00 minim= 1 <br /> F <br /> IP IIISiALLATION PLAN CHECK (Plan Review R Construction Inspectfons) TANK I.D. 0(s) <br /> L <br /> PLAN CHECK FEE 578.00/hour (8 hours minimum/FACILITY) _ ;624.00 minimum ! <br /> ° REPAIR FEE (uorkpian Review ; Construction inspections) TANK I.D. A(s) <br /> LI <br /> LANK LINING REPAIR FEE • 278.00/hour (3 hours minimum/TANK) # TANK(s) X 5234.00 = f <br /> � i <br /> I TANK RETROFIT REPAIR FEE _ ;78,00/hour (3 hours min./FACILITY) = S234.00 minim= t <br /> PiPING REPAIR FEE _ ;78.00/hour (3 hours minimum/FACILITY) = 1234.00 minimum S I <br /> I <br /> L <br /> TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION = ;78.00/hr <br /> ; <br /> C CONSULiATION FEE 578.00/hr SAMPLING INSPECTION FEE _ ;78.00/hr ; <br /> TOTAL DUE !468.00 <br /> i <br /> L OFFICE USE ONLY <br /> ii.«""aW.i iw or i!iii i.�iw iA: i i»iwi»«ii iiw»wYi iiii�i.s»ri iiwi»ii Ti�iw ii»wiwi»w iw«i wi»w ii«w iiN MMw iw i iiS iiw nw w7ii»ii+i«»iw wri iii.wii:.ri.w.w«w ni.wi <br /> rarrwrwmlamit," "MY A" "ARIF" s <br /> SL f sI <br /> rwi..r:iriii.i:..�iiw u:.:i r..i w:w iiwilii. .w.�..:... .. ........... .. .......... .............. ....................................r.'.::w:».:::v::w:.:M.:r:.»..:.»:.n.. <br /> umorim . ...a.wsurrWraMAWMWAar"WmerrsouAwnAMWONNOW$WNoOrAww�rrrwrrr�pr���is�wur�wWAWAWrAWWWAWWMAwareMwWAWrrr <br /> C-23 032 (REVISED 3-1-931 Paae 11 <br />