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JOAQUIN COUNTY PUBLIC HEALTH SER'.. <br />ENVIRONMENTAL HEALTH DIMZON <br />'RGROUND STORAGE TANK PROGRAM • FEE WORKSHEET <br />S <br />FACX�4 SITE NAME <br />FACILITY CONTACT NAME <br />T <br />1/ N7 /lD E)2TI <br />11444. Detw <br />E <br />FACILITYRE55 SITE PHONE # with AREA CODE <br />P <br />A <br />TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = S <br />I <br />R <br />TANK RETROFIT REPAIR FEE = E78.00/Maur (3 hours min./FACILITY) = $234.00 minimum s <br />CITy,,�y SjATE Z153E! at SITENKS <br />A <br />P <br />/ 44 Iv <br />P <br />APPLICANT/BILLING NAME <br />APPLICANT CQNTACT NAME <br />1989 <br />MU) <br />MAYf1C IJ(LEG(1 <br />C <br />MA ING DRESS <br />"DUB <br />PLICANT PHONE # WITH AREA CODE <br />A <br />M <br />W& inn , <br />2a4) s-Z!i, Gra <br />T <br />CIT <br />SjA�TE <br />Z CODE <br />wS3$$ <br />TYPE of APPLICATION <br />�)e <br />XXXX <br />Q(��jfp <br />(-Ar <br />XXXX <br />(Closure, Installation, etc.) <br />TOTAL <br />A <br />TANK FEE = 550.00/TANK <br />(Prior <br />to January 1,1991) <br />5170/TANK (After <br />January 1, 1991) <br />C <br />REPAIR FEE (Workplan Review 8 Construction Inspections) TANK I.O. #(s) <br />P <br />A <br />TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = S <br />I <br />R <br />TANK RETROFIT REPAIR FEE = E78.00/Maur (3 hours min./FACILITY) = $234.00 minimum s <br />PfPING REPAIR FEE = 578.00/hour (3 hours minimun/FACILITY) = 5234.00 mini=m S <br />T <br /># Tanks = <br />1986 <br />1987 <br />1988 <br />1989 <br />1990 1991 1992 1993 <br />1994 1995 1996 <br />1 <br />(multiply T y�fee for <br />V <br />E <br />each year applicable) <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />S <br />I <br />TANK PENALTY FEES ASSESSED <br />IXxxx <br />XXXX <br />I XXXX <br />XXXX <br />XXXX <br />I s <br />S <br />I <br />T <br />STATE SURCHARGE = $56.00 <br />each TANK <br />(Due <br />every 5 <br />years) <br />See California N 8 S Cade, <br />Section 25287 <br />E <br /># Tanks x 556.00 <br />1986 <br />through <br />1990 <br />1991 through <br />1996 <br />(Enter amount and year) <br />S <br />PI INSTALLATION PLAN CHECK (Plan Review 8 Construction Inspections)) TANK I.D. #(s) 'd <br />NI <br />PLAN CHECK FEE = 578.00/hour (8 hours minimum/FACILITY) = $624.00 minimum <br />I S <br />R <br />E <br />REPAIR FEE (Workplan Review 8 Construction Inspections) TANK I.O. #(s) <br />P <br />A <br />TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = S <br />I <br />R <br />TANK RETROFIT REPAIR FEE = E78.00/Maur (3 hours min./FACILITY) = $234.00 minimum s <br />PfPING REPAIR FEE = 578.00/hour (3 hours minimun/FACILITY) = 5234.00 mini=m S <br />M <br />1 <br />TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION - 578.00/hr S <br />S <br />C <br />CONSl1LTATION FEE = 578.00/hr SAMPLING INSPECTION FEE = 578.00/hr <br />S <br />TOTAL DUE <br />(97 7-, oo <br />EH 23 046 (Revised 7/10/96) Page 11 <br />ytl <br />