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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - EMVIRONMEMTAL HEALTH DIVSION <br />UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br />S <br />FACILITY SITE NAME <br />FACILITY CONTACT NAME <br />I <br />Stockton Metropolitan Airport <br />Dan De Angelis <br />T <br />E <br />FACILITY ADDRESS <br />SITE PHONE If with AREA CODE <br />TANK I.D. Y(s) <br />5000 S. Airport Wa <br />(209)468-4700 <br />t <br />CITY <br />xxxx <br />tl of TANKS 2. <br />A <br />Stockton, <br />xxxx <br />$ xxxxxxxx <br />at SITE <br />P <br />P <br />APPLICANT/BILLING NAME <br />Jim Thorpe Oil, Inc.is <br />[ANj CONjACT NAME <br />ar orpe <br />h tl $1, <br />L <br />I <br />C <br />NAILING ADDRESS <br />7Mr�2 <br />CANT PHONE Y WITH AREA CODE <br />A <br />P.O. Box 357209)368-6175 <br />xxxx <br />M <br />7 <br />CITY <br />TE <br />TYPE of APPLICATIDN R.empVal <br />1987 <br />Lodi, <br />1989 <br />1990 <br />(Closure, Installation, etc.) <br />C <br />1986 <br />1987 <br />1988 <br />1989 <br />1990 <br />$468.00 <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br />TEMPORARY CLOSURE (Plan Review 6 Inspections) <br />TANK I.D. Y(s) <br />R <br />E <br />TEMPORARY CLOSURE FEE • $78.00/hour (3 hours minimus/FACILITY) <br />$234.00 minimum <br />$ <br />xxxx <br />xxxx <br />xxxx <br />xxxx <br />xxxx <br />$ xxxxxxxx <br />A <br />C <br />7 FACILITY PENALTY FEES ASSESSED (If Applicable) <br />%xXX <br />xxxx <br />XXx% <br />xxxx <br />xxxx <br />f xxxx%x%% <br />I <br />V TANK FEE $50.00/TANK (Prior to January 1,1991) <br />$170/TANK (After January 1, 1991) <br />E <br />tl Tenke• <br />1987 <br />1988 <br />1989 <br />1990 <br />1991 <br />1992 <br />1993 <br />1994 <br />1995 <br />1996 <br />1997 <br />F (multiply tl by fa for <br />$ <br />A each year applicable) <br />xxxx <br />xxxx <br />xxxx <br />xxxx <br />xxxx <br />C <br />1 TANK PENALTY FEES ASSESSED <br />xxxx <br />xxxx <br />xxxx <br />xxxx <br />xxxx <br />f <br />L <br />I STATE SURCHARGE <br />T <br />Y X Tanks— x $8.00 <br />1988 through 1990 ($56) <br />1991 through 1996 (f56) <br />1997 <br />xx%xxxxXxxxxXxxxx:10:10 xxxx <br />x%xxxx%%%Xxxxxxxxxxxxxx <br />f <br />SURCHARGE FOR 1997 <br />C <br />PERMANENT CLOSURE (Removal or Authorized Closure -in -Placa) <br />TANK 1.0. Y(s) <br />L <br />0 <br />CLOSURE FEE • $78.00/hour (3 hours minima /TANK) <br />Y TANK(s)�_ % $234.00 <br />$468.00 <br />S <br />U <br />TEMPORARY CLOSURE (Plan Review 6 Inspections) <br />TANK I.D. Y(s) <br />R <br />E <br />TEMPORARY CLOSURE FEE • $78.00/hour (3 hours minimus/FACILITY) <br />$234.00 minimum <br />$ <br />P <br />INSTALLATION PLAN CHECK (Plan Review 6 Construction Inspections) <br />TANK I.D. #(a) <br />L <br />TANK LINING REPAIR FEE • $78.00/hour (3 hours minimus/TANK) <br /># TANK(s) % $234.00 <br />A <br />M <br />PLAN CHECK FEE • $78.00/hour (8 hours minlnuNFACILI TY) _ (624.00 minimum <br />f <br />R <br />REPAIR FEE (Workplan Review L Construction Inspections) <br />TANK I.D. tl(s) <br />E <br />P <br />TANK LINING REPAIR FEE • $78.00/hour (3 hours minimus/TANK) <br /># TANK(s) % $234.00 <br />$ <br />A <br />I <br />TANK RETROFIT REPAIR FEE • $78.00/hour (3 hours min./FACILITY) _ $234.00 minimum <br />$ <br />A <br />PIPING REPAIR FEE $78.00/hour (3 hours mini mim/FACILITY) _ (234.00 mini muni <br />f <br />N TRANSFER FEE • $20.00 <br />t <br />S <br />C 1 CONSULTATION FEE • (78.00/hr <br />OFFICE USE <br />mmos <br />SWEEPS Y <br />FN 23 032 (REVISED 5.27-97) <br />UNAUTHORIZED RELEASE EVALUATION - $78.00/hr <br />SAMPLING INSPECTION FEE = $78.00/hr <br />DIST CDDE 1 AMOUNT RECEIVED I CHECK Y/CASH <br />S <br />f <br />TOTAL DUE 1 $468.00 <br />