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S#ENVIACUIN COUNTY PUBLIC HEALTH SERVICES <br /> • RONMENTAL HEALTH DIVISION <br /> UNDERD STORAGE TANK PROGRAM - FE_ uCRKSHEET 0 <br /> ifY SITE NAME FACILITY CONTACT NAME <br /> LAWRENCE LIVERMORE NATIONAL LABORATO IES BOB SETTLE <br /> FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> I -SITE 300 CORRAL HOLLOW ROAD (51(7423-538 <br /> T CITY STATE ZIP CODE # of TANKS <br /> Y TRACY C 995376 at SITE 2 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P HESS & HESS CONSTRUCTION, INC , BILL IRONS �o <br /> I 1GIILING ADDRESS APPLICANT PHONE # WITH AREA CODE Z <br /> c3819 DUCK CREEK DRIVE <br /> N CITY STATE ZIP CODE TYPE of APPLICATION <br /> T STOCKTON CA 95215 closuRE, INSTALLATION, e �(.OSURE <br /> A <br /> TOTAL <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = S100.00 <br /> I S <br /> V <br /> TANK FEE = S50.00/TANK (prior to January 1,1991) S170/TANK (after January 1, 1991) <br /> F # Tanks = 1986 1987 1988 1984 11990 1991 1992 1993 1994 1995 1996 <br /> A (multiply # by fee for I <br /> C each year applicable) S <br /> I <br /> L STATE SURCHARGE = S56.00 each TANK (Due every 5 years) See California•H b S Code, Section 25287 <br /> 1 <br /> T # Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> Y for+w ,!-t;r AMA Year) <br /> s <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> C I <br /> L CLOSURE FEE = 553.00 per hour (3 hours minimum per TANK) # TANK(s) <br /> 0 �_ X 5159.00 S 3 18 ,0 0 (l� <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. "(s) <br /> R <br /> EETEMPCRARY CLOSURE FEE = S150.00 each TANK # TANK(s) X S150.00 = S <br /> P PLAN CHECK (Install. Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> H PLAN CHECK FEE - S53.00 per hour (8 hours minimum per Facility) = S424.00 minis n S <br /> R REPAIR FEE (workplan review & construction inspections) TANK I.D. #(s) <br /> E <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimum/TANK) # TANK(s) X 5159.00 = S <br /> A <br /> I <br /> R PIPING REPAIR FEE = S53.00 per hour (3 hour minimum per facility = S159.00) S <br /> H CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> S <br /> C FEE = S53.00/hr FEE = 553.00/hr FEE = S 53.00/hr <br /> TOTAL DUE 5 318 .00 <br /> OFFICE USE ONLY <br /> m7 wi- !crSwEt. Sa �"qri i 'ar i`0 `"`C "' �"5 `LLE �EI �'w`or <br /> CITT <br /> rn1 bra1_-TFv;ic "c At`3 to G/ 7 —��" <br /> ............_.».../ �-- <br /> y <br /> .._..,..r....�.r......,..r.......�..- .. -._.................� <br /> N 23 032 (REV 1/10/41) ft pane 11 <br /> yr 'It r.,.,... ,., . <br />