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SAN JOAQUIN COUNTI&BLIC HEALTH SERVICES-ENVIRONME'47EALTH DIVISIO` <br /> UNDERG D STORAGE TANK PROGRAM • FEE WO EET <br /> S FACILITY SITE NAME FACtIM CONTACT NAME <br /> I Lawrence Livermore National Labor LLNL C.Susi Jackson <br /> T FACILITY ADDRESS SITE PHONE N with AREA CODE <br /> E Corral Hollow Road 510 423-4881 <br /> & COY STATE E 4 OF TANKS at SITE <br /> A Tracy CA . .94550 2 for Buildin 827 <br /> P APPUCANTBI 11NG NAME �_ APPLICANT CONTACT NAME <br /> P & C <br /> L1 .Susi Jackson <br /> L MAII.12IG ADDRESS APPLICANT PHONE 0 WITH AREA CODE <br /> I 7000 East Ave_ P.O.Box 808 510 423-6577 <br /> C CITY STATE TE'CODE TYPE OF APPLICATION(Closure,Installation.etc.) <br /> A <br /> N Livermore CA 94550 Tank closure <br /> T <br /> TOTAL <br /> A ANNUAL FACILITY FEE(Prior to 1986 1987 1988 1989 1990 <br /> C January 1, 1991) =S100.00 <br /> T $ <br /> I <br /> v FACILTIY PENALTY FEES ASSESSED xxxx xxxx S <br /> E if a hcable <br /> TANK FEE=S50.557TANK(Prior to Jartuuy 1,199 1) S1701TANK <br /> After Jan 1. 1991 <br /> F OTanks= 1986 1987 1988 1989 1990 1991 1992 1993 1994 1 1995 1996 <br /> A (multiply 0 by fee for S <br /> C each year applicable <br /> I <br /> L TANKPENALTY xxx xxx S <br /> I FEES ASSESSED <br /> T STATE SURCHARGE=156 each TANK(Due every 5 years)See California HdcS Code,Section 25287 <br /> Y <br /> OTanks=®x 556,00(entez ameunt and year) 1986 through 1990 . 1991 through 1996 <br /> C PERMANENT CLOSURE(R or ia- ) TANK LD.O(s) <br /> L <br /> O CLOSURE FEE-S78. ('-hours um/T ) TANK LD.0(s) I_x 5234.00= S 234.09' <br /> S <br /> U TEMPORARY CLOSURE.(Plan Review&hspxtians) TANK LD. <br /> R I# s) <br /> E TEMPORARY CLOSURE FEE=S78.00ftur 0 TANK(s)—x 5234.00= S <br /> hours mi nimum)TANK) <br /> P INSTALLATION PLAN CHECK(Plan Rcncw&Comm cum TANK I.D. 0(s) <br /> L Ins ctions <br /> A PLAN CHECK FEE-S78.00/hour(8 hays mirintum/Facmliry)=S624.00 minimum S <br /> N <br /> R REPAIR FEE(WorkpLan Review k Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE=S78.0Www(3 hours TANK ID.0(s) x S <br /> A minimum/TANK) ;$234.00 = <br /> I TANK RETROFIT REPAIR FEE-S781hour(3 hours minimum/FACILITY)=$234 minimum $ <br /> R <br /> PIPING REPAIR FEE=S78.00/hour hour mamirnumJFA =$234.00 minimum S <br /> M TRANSFER FEE=$20.00 LTNALRRIORIIFD RELEASE EVALUATION= S <br /> I I S78.00/hr <br /> S CONSULTATION FEE=S78.0DAc SAMPLJNG INSPECTION FEE=$78.00/lr $ <br /> C <br /> OFFICIALUSEONL.Y TOTALDUE S 234'06 <br /> SWFEPSM COMPUTER# IAC DIST AMOUNT CHECK O/ RFAQVED DATERECFIYED <br /> CODE CODE RCVD CASH BY <br /> : .: •: <br /> is <br /> EH 23 032(Revised 11-1-92) <br /> 11 <br />