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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> F FACILITY SITE NAME FACILITY CONTACT NAME JACK DE WITT <br /> A CUSTOM RV WESTERN METER SERVICE, INC. <br /> C <br /> I FACILITY ADDRESS SITE PHONE I with AREA CODE <br /> L 4807 AIRPORT WAY <br /> I (209)982-5723 <br /> Y CISTOCKTON, TATE 2IP CODE 6 of TANKS I x Ia6800II x 2,000, <br /> A 95206 at s1TE 1 x 1, U g <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L WRPTPIRN MFMPPIR FRRFIVTCOR, TNR. ,TAX R. OR WTTT <br /> I NAILING ADDRESS 2735 TEEPEE DR. , STE. E APPLICA7 Px ¢ ** ulLy AREA CODE <br /> A 209 948-6114 <br /> N CITY STOCKTON STATE 6Z((p C�E TYPE of APPLICATION <br /> T CA yS2U5 CLOSURE, INSTALLATION, ate. REMOVAL <br /> A TOTAL <br /> 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) • SIDO.00 <br /> I S <br /> V <br /> E TANK FEE 150.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F 8 Tanks • 1966 1987 19" 1909 1990 1991 199N 1993 1901 1995 1996 <br /> A (multiply Twfee for <br /> C each year applicable) S <br /> 1 <br /> STATE SURCHARGE • $56.00 each TANK (Due every S years) Sea California H i S Code, Section 25287 <br /> T B Tanks x 556.00 1986 through 1990 1991 through 1996 <br /> Y (enter 950--Mt and year) <br /> f <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. f(s) <br /> L CLOSURE FEE • $53.00 per hour (3 hours minimus per TANK) f TANK(s) X $159.00 • f 477.00 <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspect ions) TAR LD. /(q - - <br /> R <br /> E TEMPORARY CLOSURE FEE • S150.00 each TANK 0 TANK(s) X 5150.00 • S <br /> P PLAN CHECK (Install. Plan Review t Construction Inspection) TANK I.D. !(a) <br /> L <br /> A <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minimus per FOCI Ifty) + 1424.00 minimus Fs <br /> R REPAIR FEE (workplan review i construction Inspections) 771 TANK 1(a) <br /> E <br /> P TANK REPAIR FEE • S53.00 per hour (3 hours minimm/TANK) f TANK(s) X 5159.00 + f <br /> A <br /> 1 <br /> R PIPING REPAIR FEE $53.00 per hour (3 hour minimus per facility • $159.00) f <br /> M TRANSFER FEE $20.00 UNAUTHORIZED RELEASE EVALUATION • $53.00/hr $ <br /> I <br /> CCONSULTATION FEE 153.00/hr SAMPLING INSPECTION FEE + S53.00/hr $ <br /> TOTAL DUE S <br /> s <br /> EN 23 ^32 (Revised 4/8/91) Page 11 <br />