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SAH JOAQUIN CO J&PUBLIC HEALTH SERVICES - ENVIRONMENTAL IVSION <br /> UW0qPkM= STORAGE TANK PROGRAM - FEE YORKSIIEET <br /> S FACILITY SITE NAMEFACILITY CONTACT NAME <br /> T Aero ,-, C-/L/7V -# 2/33 <br /> E FACILITY ADDRESS S7 PHON # kth AREA CODE <br /> & 29'10£3 W, a E k) A.) NVe,7 42- Zo9 76 - sSS-a <br /> CITY // STATE ZIP CODE # of TANKS Qlv,� 41 / UST <br /> P oG/G DA I C/4 SZdy at SITE 4 19164714 CIS <br /> P APPLICANT/BILLING NAME AP LICANT CONTA T NAME <br /> L PC p PR 00,_)L ,.5 tfoZo soN t��S NC. 'aI Ll- 1• JATsox) <br /> C MAILING ADDRESSfn� A LICA T HONE # WITH AREA CODE <br /> N Jr 4 AL)au 13 v/ /l i32 — 301p{�o <br /> T CITYSyIT� 2 C0 J TYPE of APPLICATION /gyp <br /> J�AC—tZaMjSINra F-1 S�Xf� (Closure, Installation, etc.) Sv/� <br /> TOTAL <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) _ $100.00 1986 1987 1988 1989 1990 <br /> A XXXX XXXX XXXX $ <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XXXX xxxx S <br /> I <br /> V TANK FEE = S50.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> # Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 199b <br /> F (multiply W-by—fee for <br /> A each year applicable) XXXX XXXX XXXX $ <br /> C <br /> I TANK PENALTY FEES ASSESSED XXXX XXXX XXXX $ <br /> L <br /> I STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 <br /> T <br /> Y # Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> (Enter amount and year) <br /> $ <br /> 1V <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> L <br /> 0 CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = S <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) d <br /> E TEMPORARY CLOSURE FEE = $78.00/hour (3 hours minimum/FACILITY) $234.00 minimum <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) ;JJ UU pp <br /> L <br /> A <br /> N PLAN CHECK FEE = $78.00/hour (8 hours minimum/FACILITY) _ $624.00 minimum $ <br /> R REPAIR FEE (Workplan Review & Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE = $78.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = $ <br /> A <br /> I TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = $234.00 minimum $ <br /> R <br /> PIPING REPAIR FEE = S78.00/hour (3 hours minimKm/FACILITY) = $234.00 minimum $ <br /> M TRANSFER FEE _ $20.00 UNAUTHORIZED RELEASE EVALUATION = S78.00/hr S <br /> I <br /> S <br /> C CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE = S78.00/hr $ <br /> TOTAL DUE $ <br /> F.S?it QF Imo;»! :( 41L »»•»»_ <br /> _.._. _.._...___...........r................. <br /> Minn.••'�:::»:m:;p:m:::::p;;gp�:�x.�::.:.»..................»:: _•ale•:::»::....�.:er -•••�»:»:;i;:a ..;_. ....�aurr.:::�;q::»eC?» .—• --•rte..—�x»::-:.—•�::»:::»»:L»iie^eii:::::ci^°i ....�.w,'iii <br /> - J �+�arr� # �L --��a�rrclr1�ri�-caCH Krvu_Bv----T- nnr a�ttvD f <br /> ._.... <br /> i'ei mm.._ .. .:.... ......»...... y» .........:». __•:•.•—e::.�».::».»:r»».rr......... »ems-rem •em:ar..:.^.:a:ws:ee:nsm:::se:»»:a.•»a..:••::::mr..aum..•••:::::......__..—._...V._.._.:iit <br /> .._.._. ..._...._.........................»....^ ? ?............................ ........_.._ ti._u. <br /> EH 23 032 (REVISED 4-29-94) Page 11 <br /> WATSON WEST, INC. <br /> Design • Engineering • Permit Services <br /> William E.Watson <br /> President <br /> 5849 Auburn Blvd. (916)332-3066 <br /> Sacramento,CA 95841 <br />