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SAN JOAQUIN COIJ&PUBLtC HEALTH SERVICES - ENVIRONMENTAL HEIVSION e" . <br />UNAWROUND STORAGE TANK PROGRAM - FEE YORKSHEET ° <br />`y L(TY SITE NAME ! FACILITY CONTACT NAME <br />K ILITY ADDRESS SITE PHONE # with AREA CODE <br />;! —W-.) IKl .aG 640x -Sc -Zell _585-5535' <br />CITY STATE ZIP CODE # of TANKS <br />>' C -P-, at SITE 3 <br />APP44ICANT/BILLING NAME <br />APPLICANT CONTACT NAME <br />L .—{6th -ADN <br />C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br />ALC- W. �►ito ST: 201-583 - Ss3S-' <br />N <br />T CITY STATE ZIP CODE TYPE of APPLICATION <br />(Closure, installation, etc.) G LOSI)(XLE <br />TOTAL <br />C <br />PERMANENT CLOSURE (Removal or Authorized Closure-in-Ptace) TANK I.D. #(s) <br />TANK I.D. #(s) <br />1986 1987 1 1988 <br />1989 ,1990 <br />CLOSURE FEE = S78.00/hour (3 hours minimun/TANK) # TANK(s) X 1234.00 <br />1 -70 Z <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = 1100.00 <br />A <br />N <br />PLAN CHECK FEE = $78.00/hour (8 hours mnimWFACILITY) = 1624.00 minimum $ C <br />w, <br />A <br />U <br />TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) <br />f <br />' <br />T. <br />FACILITY PENALTY FEES ASSESSED (If Apptieabie) <br />XXXX XXXX <br />x j-.. _ <br />= 1234.00 minimum 1 <br />V <br />TANK FEE = 150.00/TANK (Prior to January 1,1991) <br />1170/TANIC : CA'tter ,January <br />1 199�}f;: <br /># Tanks = 1986 1987 1988 1989 <br />1990 1991 1992 1993 1994 <br />1995 1496' <br />F <br />A <br />(multiply by fee for <br />each year applicable) <br />15r <br />1 <br />C <br />I <br />TANK PENALTY FEES ASSESSED XXXX XXXX <br />S <br />L <br />I <br />STATE SURCHARGE = 156.00 each TANK (Due every 5 years) <br />See California H & S Code, Section 25287 <br />T <br />Y <br />0 Tanks x,556.00 <br />1966 through 1990 <br />1991 through 1996 <br />(Enter amount and year) <br />C <br />PERMANENT CLOSURE (Removal or Authorized Closure-in-Ptace) TANK I.D. #(s) <br />TANK I.D. #(s) <br />L <br />0 <br />CLOSURE FEE = S78.00/hour (3 hours minimun/TANK) # TANK(s) X 1234.00 <br />1 -70 Z <br />TANK LINING REPAIR FEE = 178.00/hour (3 hours minimum/TANK) <br />A <br />N <br />PLAN CHECK FEE = $78.00/hour (8 hours mnimWFACILITY) = 1624.00 minimum $ C <br />S <br />a, <br />U <br />TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) <br />= 1234.00 minimum S <br />R <br />E <br />I TEMPORARY CLOSURE FEE = S78.00/hour (3 hams minimum/FACILITY) = S234.00 minimum <br />1 <br />P <br />INSTALLATION PLAN CHECK (Ptan-Review & Construction Inspections) <br />TANK I.D. #(s) <br />L <br />TANK LINING REPAIR FEE = 178.00/hour (3 hours minimum/TANK) <br />A <br />N <br />PLAN CHECK FEE = $78.00/hour (8 hours mnimWFACILITY) = 1624.00 minimum $ C <br />R <br />REPAIR FEE (Workplan Review & Construction Inspections) <br />TANK W, <br />E <br />P <br />TANK LINING REPAIR FEE = 178.00/hour (3 hours minimum/TANK) <br /># TANKCs)" X S234.00,*1 <br />a, <br />A <br />I <br />TANK RETROFIT REPAIR FEE = $78.00/hour (3 hours min./FACILITY) <br />= 1234.00 minimum S <br />R <br />PIPING REPAIR FEE = S78.00/hour (3 hags minimum/FACILITY) <br />= 1234.00 minimum 1 <br />M TRANSFER FEE = 120.00 <br />I <br />S <br />C CONSULTATION FEE = 178.00/br <br />UNAUTHORIZED RELEASE EVALUATION« = 278.00/hr <br />SAMPLING INSPECTION FEE = S78.00/hr <br />TOTAL DUE 1 S <br />