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Tanks & Piping <br />SAN JOAOUIN COU11SLIUBLIC HEALTH SERVICES - ENVIRONMENTAL H OIVSION <br />UAMIXIND STORAGE TANK PROGRAM - FEE WORKSHEET <br />C PERMANENT CLOSURE (Removal or Authorized Closure-in-Ptace) <br />L <br />0 CLOSURE FEE _ $78.00/hour (3 hours minimum/TANK) <br />S <br />U TEMPORARY CLOSURE (Plan Review & Inspections) <br />R <br />E TEMPORARY CLOSURE FEE _ $78.00/hour (3 hours minimum/FACILITY) <br />TANK I.D. #(s) <br /># TANK(s) 3 X $234.00 = $ 702.00 <br />TANK I.O. #(s) <br />$234.00 minimum $ <br />P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br />L <br />A s 624.00 <br />N PLAN CHECK FEE = $78.00/hour (8 hours minimum/FACILITY) _ $624.00 minimum <br />FACILITY SITE NAME <br />1986 <br />FACILITY CONTACT NAME <br />S1 <br />I <br />ARCO Facility 548 <br />Mohammad A. Taeb <br />T <br />$ <br />R <br />SITE PHONE # with AREA CODE <br />E <br />FACILITY ADDRESS <br />$ <br />1612 Hamer Lane <br />XXXX <br />209 478-2723 <br />CITY <br />STATE <br />ZIP CODE # of TANKS <br />A <br />Stockton <br />CA <br />95207 at SITE 4 <br />P <br />P <br />APPLICANT/BILLING NAME <br />APPLICANT CONTACT NAME <br />L <br />Tait & Associates <br />XXXX <br />Thomas Schoen--t-in <br />APPLICANT PHONE # WITH AREA CODE <br />C <br />MAILING ADDRESS <br />E <br />A <br />1001 GalqnL Way, Ste. 404 <br />1987 <br />510 680-6800 <br />N <br />T <br />CITY <br />STA1EJ <br />ZIP CODE TYPE of APPLICATION <br />1993 <br />Concord <br />CA <br />94520 (Closure Installation, etc.) <br />rnrae <br />C PERMANENT CLOSURE (Removal or Authorized Closure-in-Ptace) <br />L <br />0 CLOSURE FEE _ $78.00/hour (3 hours minimum/TANK) <br />S <br />U TEMPORARY CLOSURE (Plan Review & Inspections) <br />R <br />E TEMPORARY CLOSURE FEE _ $78.00/hour (3 hours minimum/FACILITY) <br />TANK I.D. #(s) <br /># TANK(s) 3 X $234.00 = $ 702.00 <br />TANK I.O. #(s) <br />$234.00 minimum $ <br />P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br />L <br />A s 624.00 <br />N PLAN CHECK FEE = $78.00/hour (8 hours minimum/FACILITY) _ $624.00 minimum <br />REPAIR FEE (Workplan Review & Construction Inspections) <br />1986 <br />1987 <br />1988 <br />1989 <br />1990 <br />A <br />I <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br />$ <br />R <br />PIPING REPAIR FEE = $78.00/hour (3 hours minimum/FACILITY) = $234.00 minimum <br />$ <br />$ <br />XXXX <br />XXXX <br />A <br />Cf <br />T <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />XXXX <br />XXXX <br />[$170/TANK <br />V <br />TANK FEE _ $50.00/TANK (Prior to January 1,1991) <br />(After January 1, 1991) <br />E <br /># Tanks = 4 <br />1986 <br />1987 <br />1988 <br />1989 <br />1990 <br />1991 <br />1992 <br />1993 <br />1494 <br />1995 <br />1996 <br />F <br />(multiply # by fee for <br />S <br />A <br />each year applicable) <br />XXXX <br />XXXX <br />680.00 <br />C <br />S <br />I <br />TANK PENALTY FEES ASSESSED <br />XXXX <br />XXXX <br />L <br />I <br />STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 <br />T <br />Y <br /># Tanks 4 x $56.00 <br />1988 through 1990 <br />1991 through 1996 <br />(Enter amount and year) <br />$ 224.00 <br />C PERMANENT CLOSURE (Removal or Authorized Closure-in-Ptace) <br />L <br />0 CLOSURE FEE _ $78.00/hour (3 hours minimum/TANK) <br />S <br />U TEMPORARY CLOSURE (Plan Review & Inspections) <br />R <br />E TEMPORARY CLOSURE FEE _ $78.00/hour (3 hours minimum/FACILITY) <br />TANK I.D. #(s) <br /># TANK(s) 3 X $234.00 = $ 702.00 <br />TANK I.O. #(s) <br />$234.00 minimum $ <br />P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br />L <br />A s 624.00 <br />N PLAN CHECK FEE = $78.00/hour (8 hours minimum/FACILITY) _ $624.00 minimum <br />N TRANSFER FEE = $20.00 UNAUTHORIZED RELEASE EVALUATION = $78.00/hr $ <br />I <br />S $ <br />C CONSULTATION FEE = $78.00/hr SAMPLING INSPECTION FEE = S78.00/hr <br />TOTAL DUE S 2,230.00 <br />FOR OFFICE USE ONLY <br />.... j•x:n. ... ...... ........:::::.s:.:::.r..:.:n::a'a?i?i!ii!!:«:L�•?«:ie �?;rr^s r;.rxn:r^gr!!ii::isnns!!ie^f!i:s!:!r;p;sr;^nr.'i�"i!-:!:^•i_r.::e, <br />:it3?L.:"�•«•fd!?Lry[!2'???iM•i::c•T:P�:riei?s?£!??iFEH::::R!e-t???±?teFLn:?i�Eiit:isn�y!t_'r.:3i�=!4gjE?°_re?:E=?EE:i:e-cj �??!�Y.isj'r.•'v� �x :!!?:!_j�!?'?ii???eF??z �<iiiiir..iiY1i�?�?u:� •i9Hi. <br />SWEEPS # COMPUTER # LOC CODE I DIST CODE I AMOUNT RECEIVED I CHECK #/CASH <br />$ <br />Ell 23 032 (REVISED 10-28-93) <br />RECEIVED BY DATE RECEIVED <br />REPAIR FEE (Workplan Review & Construction Inspections) <br />TANK I.D. #(s) <br />R <br />E$ <br />P <br />TANK LINING REPAIR FEE = S78.00/hour (3 hours minimum/TANK) <br /># TANK(s) X 5234.00 = <br />A <br />I <br />TANK RETROFIT REPAIR FEE = $78.00/hour (3 hours min./FACILITY) _ $234.00 minimum <br />$ <br />R <br />PIPING REPAIR FEE = $78.00/hour (3 hours minimum/FACILITY) = $234.00 minimum <br />$ <br />N TRANSFER FEE = $20.00 UNAUTHORIZED RELEASE EVALUATION = $78.00/hr $ <br />I <br />S $ <br />C CONSULTATION FEE = $78.00/hr SAMPLING INSPECTION FEE = S78.00/hr <br />TOTAL DUE S 2,230.00 <br />FOR OFFICE USE ONLY <br />.... j•x:n. ... ...... ........:::::.s:.:::.r..:.:n::a'a?i?i!ii!!:«:L�•?«:ie �?;rr^s r;.rxn:r^gr!!ii::isnns!!ie^f!i:s!:!r;p;sr;^nr.'i�"i!-:!:^•i_r.::e, <br />:it3?L.:"�•«•fd!?Lry[!2'???iM•i::c•T:P�:riei?s?£!??iFEH::::R!e-t???±?teFLn:?i�Eiit:isn�y!t_'r.:3i�=!4gjE?°_re?:E=?EE:i:e-cj �??!�Y.isj'r.•'v� �x :!!?:!_j�!?'?ii???eF??z �<iiiiir..iiY1i�?�?u:� •i9Hi. <br />SWEEPS # COMPUTER # LOC CODE I DIST CODE I AMOUNT RECEIVED I CHECK #/CASH <br />$ <br />Ell 23 032 (REVISED 10-28-93) <br />RECEIVED BY DATE RECEIVED <br />