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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICE.5-ENVIRONNIENTAL HEALTH DIVISION000188 <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> I Lawrence Livermore National LaN,mto (LLNL) C. Sum Jackw,n <br /> T FACILITY ADDRESS SITE PHONE#wnit AREA CODE <br /> E Corral Hollow RoaJ (iln) 4234xxl <br /> & = STATE ZIPCODE MOF TANKS at SITE <br /> A ;c,uthwest of Tracv CA 94550 S for Butl.hntt 879 <br /> P APPLICANT/BILLINGNAME APPLICANT(T)NTAC'TNAME <br /> P LLNL C Sua Jack-,n <br /> L MAILING ADDRESS APPLICANT PHONE M WITH AREA CODE <br /> I 10M) Ea,t Ave.. PO Hox X09. (iU)) 421.4577 <br /> C CITY STATE ZIPCUUE TYPE()F APPLI ATION lCloaure.Inatallauun,coca) <br /> N Livermore CA )4ii() Tank,1o.ure <br /> T <br /> T,;T 7L <br /> A k. \I.AL FACILITY FEE iRnoi t, l ern }vrc7 l•,AA iytiv i.) <br /> C January 1. 199 1) =Sl(Xt.11l) <br /> S <br /> T <br /> r <br /> V FACILITY PENALTY FcES ASSESSED xzzz zxzx S <br /> E (if a livable) <br /> TANK FEE=S54.(X TANK(Pnor to January I. 199L) S1701TANK <br /> After January 1. 199 1) <br /> F #Tanks = 1986 1997 1988 1989 I'M) 1991 199: 1993 1994 1995 1996 <br /> A (multiply #by fee for S <br /> C each year applicable <br /> I <br /> L TANK PENALTY zzz zxz S <br /> I FEES ASSESSED <br /> T STATE SURCHARGE=S56 cacti TANK(Due every 5 years)Sae Calid�rnw H�ScS Code.Secuun 25287 <br /> Y <br /> #Tanks:_z 556.00(enter .,mount anal y.ar) 1986 thn,ueh 19% 1991 through 1996 <br /> S <br /> I V-7��� <br /> i J=N <br /> C EFR. <br /> ENT CLOSURE tRemrval or AuthaKizeal Ck�wre•tn•Platx) TANK [.D.#(s) <br /> L <br /> O E FEE-579.00/lniur t?hour%mintmum/TANK) TANK I.D.#(c) 1 z 5234.00= S 234. <br /> S <br /> Lt RY CLOSURE(Plan Review dt Inspcctions) TANK I.D. <br /> R #tc) <br /> E ARY CLOSURE FEE=S78.tVvh1ur #TANK(s)_z 5234.00= S <br /> mum/TANK) <br /> P INSTALLATIONPLAN CHECK(Plan Review&C omttuctioo TANK I.D. #(s) <br /> L Inspections) S <br /> A PLAN CHECK FEE-$78.00/hour(8 hours minimum/Facilay)=$624.00 minimum <br /> N <br /> R REPAIR FEE(workplan Review &Construction Inspectiens) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE=S78.004iuur(3 hours TANK I.D.#(s) x S <br /> A minimum/TANK) $234.00 = <br /> I TANK RETROFIT REPAIR FEE=S78/hour 13 lu,urs minimum/FACILITY)=S234 minimum S <br /> R <br /> PIPING REPAIR FEE=S78.(X)/huur(3 hour mr:•:mumiFAC•ILITY)=S234.0()minimum S <br /> M TRANSFER FEE=S20.00 LQVAl1T IORQ D RELEAASE EVALUATION- S <br /> I S78.(X)/hr <br /> S CONSULTATION FEE=S79.1))rltr SA61PLINC INSPE(M-7 N FEE=S78.00/hr 5 <br /> C <br /> OFFICIAL USE ONLY TOTAL DUE S 234, <br /> SWEEPS# COMPIriERa LOC DIST AM()1 rNT CHECK#/ RECEIVED DATE RECEIVED <br /> CODE R('VI) CASH BY <br /> EH 23032(Revibed 11-1-92) <br /> 11 <br />