COMPLIANCE INFO_FILE 12 - Laserfiche WebLink

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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET FACILITY NAME FACILITY CONTACT NAME Lawrence Livermore National Laboratory — Site 300 Shari Brigdon FACILITY ADDRESS SITE PHONE # WITH AREA CODE Corral Hollow Rd near 1-580 (925) 423-7665 CITY STATE ZIP CODE # OF TANKS AT SITE Tracy CA 95376 3 APPLICANT BILLING NAME APPLICANT CONTACT NAME LLNL — Site 300 Mishell Pendleton APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE P.O. Box 808, L-695 (925) 422-7482 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE: Closure Installation Repair Retrofit Livermore CA 94551 ACTIVE FACILITY TANK ID # (s): $500 FEE INCLUDES FACILITY FEE + 1 TANK1999 $125 PER TANK AFTER FIRST TANK 2000 2001 2002 ($170)X(#tanks) $170)X(#tanks) 2003 2004 TANK ID # (s): TEMPORARY CLOSURE FEE = $279 / FACILITY $ SAMPLING INSPECTION FEE = $ 93/ HOUR TANK PENALTY ASSESSED $ TANK SURCHARGE = $15/TANK $ STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$24.00 FACILITY $ PERMANENT CLOSURE Removal or Permitted Closure in Place TANK ID # (s): CLOSURE FEE = $279/ TANK # TANKS X $279 = TEMPORARY CLOSURE Plan Review and Inspections) TANK ID # (s): TEMPORARY CLOSURE FEE = $279 / FACILITY INSTALLATION PLAN CHECK Plan Check and Construction Inspections) TANK ID # (s): PLAN CHECK FEE = $744 / FACILITY $ REPAIR PLAN CHECK TANK ID # (s): 390002319450505184 (879-G3U1) TANK RETROFIT REPAIR FEE =$279 FACILITY (use for monitoring equipment spill buckets tank sumps misc.) $279 PIPING REPAIR FEE =$279 / FACILITY (use for piping, under -dispenser containment, ect.) $ MISCELLANEOUS TRANSFER FEE = $20 CONSULTATION FEE = $ 93/ HOUR UNAUTHORIZED RELEASE EVALUATION FEE = $ 93/HOUR SAMPLING INSPECTION FEE = $ 93/ HOUR ALL FEES ARE BASED ON THE $93 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. OFFICE USE ONLY Service Re uest Facility ID Amount Received Check # Received by ate Received SR