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1 <br /> i <br /> I <br /> ISAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F Steve Yocam <br /> A Riverside Cement Co <br /> ! SITE PHONE f with AREA CODE <br /> FACILITY ADDRESS (209)948--0520 <br /> L 2825 W Washington St <br /> T CITY STATE ZIP CODE f of TANKS <br /> C21 52x3 at SITE <br /> T <br /> Stockton <br /> APPLICANT CONTACT NAME <br /> A APPLICANT/BILLING NAME <br /> P Riverside Cement Co. Accounts Payable Mike Seixes <br /> C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> P.0 Box 4904 <br /> A <br /> STATE ZIP CODE TYPE of APPLICATION Removal <br /> N CITY �A. 91765 CLOSURE, INSTALLATION, etc. <br /> T Diamond Bar <br /> TOTAL <br /> A 1986 1987 1488 1969 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) $100.00 ; <br /> V $170/TANK (after January 1, 1991) <br /> TANK FEE _ $50.00/TANK (prior to January 1,1991) <br /> p Tenks 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> (Mu ltiplyi<Ty"'fee for $ <br /> C each year eppllcable) <br /> I <br /> L STATE SURCHARGE = 156 DO each TANK (Due every 5 years) See Cellfornia H $ S Code, Section 2 <br /> 5287 <br /> TITanks x $56 00 1986 through 1990 <br /> (enter VZMt and ye1991 through 199b <br /> y ar) $ <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place)IN ETAKK I.D. 0(s) <br /> C X 5159.00 = $ 159.00 <br /> L CLOSURE FEE _ $53 00 per hour (3 hours minim m per TANK) K(s)�_ <br /> 0 <br /> S - <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. (s) <br /> — <br /> R f TANK(s) X 1150 00 = _ <br /> E TEMPORARY CLOSURE FEE ■ $150.00 each TANK <br /> P PLAN CHECK (Install. Plan Review R Construction Inspections) TANK I.D. f(s) <br /> L <br /> H PLAN CHECK FEE - $53 00 per hour (8 hours minimum per Facility) <br /> = $424.00 minimua $ <br /> R REPAIR FEE (workplen review Z construction inspections) TANK I.D. f(a) <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours min1ft0jWTANK) f TANK(s) X $154 D0 * $ <br /> A <br /> R PIPING REPAIR FEE = $53.00 per hour (3 hour minimus per facility = $159.00) $ <br /> M TRANSFER FEE <br /> = 520.00 UNAUTHORIZED RELEASE EVALUATION = $53.00/hr $ <br /> I <br /> C CONSULTATION FEE = $53 DO/hr SAMPLING INSPECTION FEE <br /> = S53.00/hr $ <br /> TOTAL DUE $ <br /> tI 23 032 (Revised 4/8/91) Page 11 <br />