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SAN JOAQUIN IC HEALTH VICES - ENVIRONMENTAL HEALTH" ION <br />UNDER;4 STORAGE TANK PROGRAM - FEE WORKSHEET <br />S <br />FACILITY SITE NAME <br />FACILITY CONTACT NAME <br />I <br />ANASTASIO'S AM/PM MINI MART <br />Jack AnasfffOgRONENTAL HEALTH <br />I <br />V <br />TANK FEE = SSO.00/TANK (Prior to January 1,1991) <br />S170/fANK (After Jon ry 1, 1991) <br />T <br />E <br />i <br />fAClLITY ADDRESS SITE PHONE # with AREA Et`ml [ SERVICE <br /># Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br />(muttipty # by fee for <br />each year appl icabte) Do oo jol (� <br />3425 Tracy Blvd (209) 835-1 <br />& <br />TANK PENALTY FEES ASSES )0= XXXX <br />CITY STATE ZIP CODE # of TANKS <br />L <br />I <br />Trac CA 95376 at SITE <br />P <br />P <br />APPLICANT/BILLING NAME <br />APPLICANT CONTACT MAME <br />1986 through 1990 <br />ANASTASIO'S AM/PM MINI MART <br />Chester Bennett <br />I <br />C <br />MAILING ADDRESS c/o TAIT & ASSOCIATES, INC. <br />APPLICANT PHONE # WITH AREA CODE <br />A <br />2880 Sunrise Blvd, #206 <br />(916) 635-2444 <br />N <br />C <br />T <br />CITY STATE ZIP CODE TYPE of APPLICATION <br />Rancho Cordova CA 95742 CGI e, Instattation, etc.) Closure <br />TOTAL <br />AExx: <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br />1986 1987 19W 1989 1990 <br />5 <br />C <br />T <br />FACILITY PENALTY FEES ASSESSED (If Applicabte) <br />)0= <br />S <br />I <br />V <br />TANK FEE = SSO.00/TANK (Prior to January 1,1991) <br />S170/fANK (After Jon ry 1, 1991) <br />E <br />F <br />A <br /># Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br />(muttipty # by fee for <br />each year appl icabte) Do oo jol (� <br />S <br />C_jL <br />I <br />TANK PENALTY FEES ASSES )0= XXXX <br />S <br />L <br />I <br />STATE SURCHARGE = S56.00 each TANK (Due every S years) See California N & S Code, Sectio' 25287 <br />T <br />Y <br /># Tanks x 556.00 <br />(Enter amort and year) <br />1986 through 1990 <br />1991 through 1996 <br />. <br />S <br />C <br />PERMANENT CLOSURE (RemovaL or Authorized CI in-Ptace) <br />TANK I.O. #(S) <br />L <br />0 <br />CLOSURE FEE a 578.00/hoar C3 hours mini TANK) <br /># TANK(s) X 5234.00 = <br />S <br />S <br />U <br />TEMPORARY CL (Ptan Review & Inspection) <br />TANK I.O. #(s) <br />R <br />E <br />ITEMPORARY CLOSURE FEE = S78.00/hour (3 hours mini FACILITY) <br />= 5234.00 minimum <br />s <br />P <br />INSTALLATION PLAN CHECK (Plan Review & Construction I ti ) <br />TANK I.D. #(a) <br />L <br />A <br />N <br />PLAN CHECK FEE = S78.00/hour C8 ham minimum/FACILITY) <br />= S624.00 minion. <br />IS <br />R <br />REPAIR FEE (Workptan Review & Construction I ti ) <br />TANK I.O. #(s) <br />E <br />P <br />TANK LINING REPAIR FEE a 578.00/hoar (3 hours minimum/TANK) <br /># TANK(s) X 5234.00 = <br />S <br />A <br />I <br />R <br />TANK RETROFIT REPAIR FEE = S78.00/hour C3 hours min./FACILITY) <br />PIPING REPAIR FEE = 578.00/hour (3 hours mini FACILITY) <br />_S234.00 minion <br />= SM.00 minimum <br />S <br />S <br />M <br />TRANSFER FEE a S20.00 twurmtzw RELEASE EVALUATION a S78.00/hr <br />5 <br />I <br />S <br />C <br />CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE <br />= S78.00/hr <br />S <br />TOTAL DUE <br />S hi/. i <br />EH 23 032 !REVISED 3-1-931 Page 11 <br />