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SAM JOAOUIN COUNTY PUBLIC HEALTH SERVICES - ENVIROMNEMTAL HEALTH DIMON <br />UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br />S <br />I <br />FACT iT $I MANE <br />%IV <br />Cl ITT TACT NAME <br />T <br />1990 <br />E <br />FACILITY ADD%SS <br />SITA. PHONE 0 elth AREA Cme <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />loon( %)00( <br />A <br />Cl TY _ <br />STATE <br />ZIP CODE <br />O of TANKS <br />s Tanks a <br />(muttlply E by fee for <br />each year appllcable)$ <br />1986 <br />1987 <br />1988 <br />at SITE <br />D <br />. <br />1992 Tlnl±4J1995 <br />P <br />OKICANT/OILLIMO MAZE�/� <br />� <br />Ap T NAME <br />`^' TA <br />l <br />C <br />A <br />MAI IMO <br />j7nVe <br />PNOW 0 YITM AREA CODE <br />"` - <br />M <br />_ <br />T <br />cITY <br />ST TE <br />zlr cmc` TYPE <br />, II sof APPL ltaltsstlon, etc.) ck/ 1 e- <br />A <br />C <br />ANNUAL FACILITY FEE (Prior to Jewry 1, 1991) a $100.00 <br />1 <br />1966 1987 1986 <br />19x9 <br />1990 <br />3 <br />T <br />I <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />loon( %)00( <br />S <br />V <br />E <br />TANK FEE a %50.00/TA)K (Prior to Jarwry 1,1991) <br />II <br />$170/TANK (After January 1, 1991) <br />F <br />A <br />C <br />s Tanks a <br />(muttlply E by fee for <br />each year appllcable)$ <br />1986 <br />1987 <br />1988 <br />1969 <br />1990 <br />1991 <br />1992 Tlnl±4J1995 <br />1996 <br />I <br />L <br />TANK PENAL IT FEES ASSESSED <br />7000( <br />K)00I <br />S <br />I <br />T <br />STATE SURCHARGE a $56.00 each TANK (Due every S years) See California H L S Cafe, Section 25287 <br />T <br />P Tanks R $56.00 <br />(Enter a t and year) <br />1966 through 1990 1991 through 1996 <br />s <br />C <br />L <br />PERMANENT CLOS(RE (Removal or Authorlid Closure -In -Place) TANK I.D. S(s0 <br />0 <br />S <br />CLOSURE FEE • $78.00/hour (3 hours ■Infosia/TANK) S TANK(s)_ K $234.00 • <br />f <br />U <br />R <br />TEMPORARY CLOSURE (Fish Review L Inspections) TANK I.D. f(a) <br />E TEIPORAAT CLOSURE FEE a $78.00/hour (3 hours alnlmWFACILITY) a $234.00 Minfala <br />S <br />P <br />L <br />IMSTALLATIOM PLAN CHECK (Plan Review i Construction InslsetlanU TANG I.D. S(a) <br />A <br />R <br />PLAJI CHECK FEE a $75.00/hour IS hours ofniffLWFACILITT) ■ 5624.00 alnisAs <br />$ <br />R <br />E <br />REPAIR FEE (Workplan Review $ Construction Inspections) <br />TANK I.D. s(a) <br />P <br />A <br />TANK LIMING REPAIR FEE a !78.00/hour (3 haus minimum/TANK) <br />E TANK(s) K s234. 00 . f <br />1 <br />R <br />TANK RETROFIT REPAIR FEE a $78.00/how (3 hours aln./FACILITY) • $234.00 ainisue $ <br />PIPING REPAIR FEE a 178.00/hour (3 hoax's alnla WFACILITY) • s23f.00 minim $ <br />N <br />1 <br />TRANSFER FEE a SM. 00 UTAUTNOR IZED RELEASE EVALUATION a $78.00/hr f <br />S <br />C <br />CONSUL TATIOM FEE • $78.00/hr SANPL IMO IMSKCTIOM FEE a f78.00/hr S <br />TOTAL DUE S <br />FOR OFFICE USE ONLY <br />EN 23 032 (REVISED 3-1-93) Peat 11 <br />