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T <br />"E <br />� g <br />A <br />P <br />P <br />L <br />1 <br />C <br />A <br />N <br />T <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALl. .IVSICIN <br />UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br />FACl/U TY SITE NAME <br />PERMANENT CLOSURE (Removal or Authorized Closure -fm Place) I <br />FACILITY CONTACT NAME <br />L <br />TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) I <br />A6 I <br />FACILIT ADDRESSI <br />CLOSURE FEE = 378.00/hour (3 hours minimum/TANK) iT <br />SITE PHONE/ It with AREA CODE <br />S <br />U <br />TEMPORARY CLOSURE (Plan Review 3 Inspections) <br />TANK I.D. �(s) <br />CIS <br />TEMPORARY CLOSURE FE=_ = 378.00/hour (3 hours minimum/FACILITY) I <br />S__TAAnTEI <br />!JT <br />ZIP CODE <br />I of TANKS <br />at SITE <br />'PPLICAN <br />1989 <br />11990 <br />ANNUAL FACILITY FEE (Prior <br />BILLING NAME <br />$100.00 <br />APPLJCANT CONTACT --NAME <br />J � _ <br />M[SING ADDR 5 <br />APPLICANT PHONE 9 WITH AREA CODE <br />'/lSTATE ZIP CODE i TYPE of 1-1".JJON_ �- I <br />I (Closu A�Ins�allatio�il etc.)>y'Js <br />7CTC�G-mom�I�� <br />CI <br />PERMANENT CLOSURE (Removal or Authorized Closure -fm Place) I <br />TANK I.D. =(s) <br />L <br />TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) I <br />I TANK(s) X 5234.00 = 5 <br />0 <br />CLOSURE FEE = 378.00/hour (3 hours minimum/TANK) iT <br />= <br />TANK(s) x 5234.00 5 <br />S <br />U <br />TEMPORARY CLOSURE (Plan Review 3 Inspections) <br />TANK I.D. �(s) <br />R <br />El <br />TEMPORARY CLOSURE FE=_ = 378.00/hour (3 hours minimum/FACILITY) I <br />i <br />5234.00 minimum 1 5 <br />L1986 <br />11987 <br />11988 i <br />1989 <br />11990 <br />ANNUAL FACILITY FEE (Prior <br />to January 1, 1991) = <br />$100.00 <br />XXXX <br />I XXXX <br />I XXXX I <br />XXXX <br />I XXXX <br />S XXXXXXXX <br />A <br />C <br />T FACILITY PENALTY FEES ASSESSED (If Applicable) <br />I XXXX <br />XXXX <br />I XXXX I <br />XXXX <br />I XXXX <br />3 XXXXXXXX <br />i <br />V TANK FEE = 350.00/TANK <br />(Prior to January 1,1991) <br />5170/TANK <br />(After <br />January <br />1, <br />1991) <br />E <br />T Tanks = <br />1988 11989 1990 <br />1991 <br />1992 <br />11993 1994 <br />1995 <br />11996 11997 <br />11998 <br />F (multiply 4 !:�y fee for <br />I <br />I <br />15 <br />A each year applicable) <br />I XXXX XXXX I XXXX <br />i XXXX <br />(XXXX <br />i I <br />I <br />C, <br />II TANK PENALTY FEES ASSESSED <br />I XXXX I XXXX I XXXX <br />XXXX <br />lXXXX <br />I <br />I <br />I <br />3 <br />L <br />I STATE SURCHARGE FCR NEW FACILITIES CNLY=518.50 <br />5 <br />T <br />Y » Tanks x 58.00 <br />I 1988 through <br />1993 <br />($56) <br />1993 <br />through <br />1997 (S56) <br />1998 <br />SURCHARGE FOR 1998 <br />XXXXXXXXXXXXXXXXXXXXXXXXXXX <br />i XXXXXXXXXXXXXXXXXXXXXXX <br />5 <br />CI <br />PERMANENT CLOSURE (Removal or Authorized Closure -fm Place) I <br />TANK I.D. =(s) <br />L <br />TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) I <br />I TANK(s) X 5234.00 = 5 <br />0 <br />CLOSURE FEE = 378.00/hour (3 hours minimum/TANK) iT <br />= <br />TANK(s) x 5234.00 5 <br />S <br />U <br />TEMPORARY CLOSURE (Plan Review 3 Inspections) <br />TANK I.D. �(s) <br />R <br />El <br />TEMPORARY CLOSURE FE=_ = 378.00/hour (3 hours minimum/FACILITY) I <br />i <br />5234.00 minimum 1 5 <br />INSTALLATION PLAN CHECK (Plan Review b Construction Inspections)I TANK I.D. =(S) <br />1 <br />I PLAN CHECK FEE = 578.00/hour (8 hours minimum/FACILITY) = 5624.00 minimum 5 <br />R <br />REPAIR =CE (Workplan Review 3 Construction Inspections) I <br />TANK I.D. 1(s) <br />E <br />P <br />TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) I <br />I TANK(s) X 5234.00 = 5 <br />A <br />I <br />TANK .RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) <br />= 5234.00 minimum 5 <br />R <br />PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) <br />= 5234.00 minimum 5 <br />.................................................................... <br />EH 23 032 (REVISED 1 12 98) <br />