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SAN JOA3CUIN NTY P1.K3LIC HEALTH SERVICES - ENVIRWKEMTAEjKA1.TH DIVSICN <br /> RGRCUND STORAG'c TANK PROGRAM - FEES WORKS <br /> 91 FACILITY SITE NAME j FACILITY CONTACT NAME <br /> I YOSEMITE 76 Beck2 Nicklas <br /> EiIFACILITY ADDRESS WS PRONE ' with AREA CODE <br /> 1700 E. YOSEMITE HWY-99 209.) 823-7676 <br /> Ci TY STATEi ZIP COLE 9 of TANKS <br /> A MANTECA I CAI 95336 at SITE 2 <br /> P AP6LICANT/13ILLING NAME i APPLICANT CONTACT NAME <br /> ; Li API a Division of LAS i Ste hen Westerfield <br /> C. MAILING ADDRESS APPLICANT PHONE 0 WITH AREA CODE <br /> A 1124242-61 do <br /> ' x <br /> Ti CITY I STAT_ ZIP CODE TYPE of APPLICATION REPAIR <br /> Milpitas CA 95035 yCtosure, Ins;attation <br /> TOTAL <br /> i t 1986 f 19$7 ! 19$8 1989 1 ?990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = S100.00 <br /> A xXXx XX%x xxxx ; 5 <br /> Tj FACILITY PENALTY FEES ASSESSED (if A000 Ca0k e) I XXXX XXXX XXXX i $ <br /> V TANK F'cc = $50.'00/TANK (Prior to Jars�:ary 1,?991) 5170/TANK (Alter January 1, 1901) <br /> Ei <br /> N Temks : C 14861 1937 7985 1989 1990 i991 i 1992 f 1993 € 1994 i 1945 11946 <br /> F (muttiplY w aY fee far ! <br /> A each year appiicabta) XXXX XXXX XXXX <br /> C - - <br /> ii TANK PENALTY FEES ASSESSED is XXXX 4 XXXX � XXXX <br /> I STAT& SURCHARGE = S56.00 earn TANK (Due every 5 Years) Sae California H S Code, Section 25287 i <br /> T <br /> Y 0 Tanks x S56.06 f 1988 through 1990 � 1991 through 1,996 <br /> (Enter amount an0 year) 7 <br /> C+ ?ERMANENTCLOSURE (A vat orAuthorized Closure-in-Ptara) TANK I.9. #{'S) I <br /> L <br /> 0 CLOSURE t'e-9 = S78-00/hour (3 hours mimiman/TANK) I TANK(s). X 5234-00 = s <br /> UI TEMPORARY --LOSURB (?tam Review & Inspections) TANK I.D. *(9) # <br /> i t <br /> g; R <br /> ? Ej TEMPORARY CLOSURE FEB i 678.00/hour (3 hours minimum/FACILITY) } $234,00 minimum � S <br /> .�..r®.�...� .... r <br /> P1 INSTALLATION PLAN CHECK (Ptah Review & ConstrUCtion InSAections)l TANK I.D. 0(s) <br /> L <br /> AlNPLAN CHECK PEE = 578.00/hour ,18 yours minimum/FACILITY) = 3624.00 .minimum S <br /> R REPAIR PEI (WOrkotan Review b Construct;on Inspections) TANK I.R. *('!s) <br /> E ' <br /> P TANK LINING REPAIR FEE a SM 00/hour (3 hours minimum/TANK) } 0 TANK($) X s234,00 = 3 <br /> A <br /> I TANK RETROFIT REPAIR F_2 = 573.00/hour (3 hours min./FACILITY) = 3234,00 Minimum S234 .00 <br /> E <br /> R f <br /> PIPING REPAIR FEE = 578.00/hour (5 hours minimum/FACILITY) = SZ34,00 minimum 3 <br /> n <br /> TRANSFER F_'< 520.00 UNAUTHORIZED RELEASE EVALUATION a 578.00/hr 3 <br /> S � <br /> C� CONSULTATION FE'e _ 378.OD/hr I SAMPLING INSPECTION FEE = 378,00/hr { S <br /> TOTAL DUE s 2-3 4 .0 0 <br /> FOR OFFICE USE ONLY ! _ <br /> ��:et�nr4...ccc :.- .—•.....r-.._—_._._;.....:ce:o:?4 eilr�r3 L.=.° E=_:z,L--.gmn am a+a._ wu u.n ...�.--:�»-::„_'.i!G i l M'?� _—E .Ta==_::i- _::....... <br /> ......_..—._..__—_.....-_...._.. _ �13111i.,r. �•=z•-z•••s ��__�=._.yrs t:•-�.._ <br /> ii '^:a.�”etiiiSlRiEiiiRi:.•a^ub:=.�r::.�:-•.�::8_::=.__°_:__�.--3mirR�iiiE3iltiANflFitPx.3T�Ji3&".u'iue;•�.�.a",ari.ir.-_.._---•--:�__.::._:rs::�ll,�tiiiii�izn.-a7;iEE•re_.uua_iiu;i,uL�'=....._......--..=.=.::. ip�'iniiew�"ra3in <br /> SWEEPS 0 � COMPUTER 1 i LOC CODE � DIST CODE I AMOUNT RECEIVED � CHECK /CASH! I RECEIVED 3Y i )AT, RECEIVE) <br /> r r r. .:mma.—r s�•� eF.IAa3SIT!'4 ::r_ !!.iiilllfi!._:•..:.•_::-1 - __N_r�c ::::a'?"txFIT!ftlii :•_:-'--— is=a=..."-?-.':=E•�"d qv'-• <br /> rREMBEEIR vv7:n sa3-:ss'e'vc3u^aw'iiS t7iitircmx�'r:x..—.._- s._ :!GSfSS'C3Atiiiii:cE_:--=F:--_..zs:rra::sLlii i31!#Ir i 3i a 7!:iSTt:iilC{L'L'.c-�--in31UR3i::ici3i5F C--—"=EEcEiiui ii i.itinil.«7«ri...:S JIr„� �ldS�„CIiA:i 3.r31i�1i JwLYJr:::rte:••vrsuw <br /> Vi 23 032 (REVISED 4-29.94) <br /> 1 <br />