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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> IM <br /> UNDERGROUND STORAGE TANK PROGRA - FEE WOrCSHEET <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> I City of Stockton Parkin <br /> E FACILITY ADDRESS IZ�� 51)%,4 h "r((Grh G4ref,i- SITE PHONE # with AREA CODE NO Phone <br /> Waghinat-nn qt-& SWE ;:IP CODE atoSITE ANKS <br /> A Z <br /> CITY Stockton C:A <br /> P APPLICANT CONTACT NAME <br /> P APPLICANT/BILLING NAME <br /> L Advanced <br /> C' <br /> MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> A <br /> N STATE ZIP CODE TYPE of APPLICATION <br /> Stockton CA 2 <br /> T <br /> CITY (Closure, Insta(lation, etc.) <br /> TOTAL <br /> A TANK FEE _ $50.00/TANK (Prior to January 1, 991) 5170/TANK (After January 1, 1991) <br /> T # Tanks 1986 _19871 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> 1 (multiply 8-6y—fee for S <br /> V each year applicable) xxxx %XXX xxxx xxxx XXXX <br /> E S <br /> TANK PENALTY FEES ASSESSED I xxxx I xxxx xxxx xxxx XXXX <br /> S <br /> 1 STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 2520 <br /> T1986 through 1990 1991 through 1996 <br /> E # Tanks x $56.00 <br /> (Enter amount and year) S <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> X 5234.00 = E o <br /> 0 CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) <br /> STANK I.D. #(S) <br /> U TEMPORARY CLOSURE (Plan Revjew & Inspections) <br /> E TEMPORARY CLOSURE FEE = 578.00/hour (3 hours minimum/FACILITY) $234.00 mini mum $ <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A = 5624.00 minimum $ <br /> N PLAN CHECK FEE = $78.00/hour (8 hours minimum/FACILITY) <br /> R REPAIR FEE (Workp(an Review & Construction Inspections) TANK I.D. #(s) <br /> ES <br /> P TANK LINING REPAIR FEE = 578.00/hour (3 hours miniTANK) # TANK(s) _ X $234-00 = <br /> A $ <br /> I TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) _ $234.00 minimum <br /> R = $234.00 minimum S <br /> PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) <br /> NJ TRANSFER FEE = $20.00 UNAUTHORIZED RELEASE EVALUATION = 578.00/hr <br /> S <br /> I <br /> S = C11 K/hr $ <br /> C CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE <br /> TOTAL WE <br /> y <br /> 'f- su ' vsi a e'aMao'r —# roc taE altr (wEudr aEc�tvzD cd€��#/cAsd a�c�lv�n s+ k� <br /> 11 .mn!m!mvnmmn...:!f�!nnm!r::!w^..^.:!nn!mnrm^!!.^..;!!ml:eg!wmr=nnxmmcn;=. umg;imp!+mn; wia':`:;wi" i� :a(m w:vlui ;viisi;iiiiuiid <br /> d:�!!:mmc!!^.i!!!!nrs!a:m!!u!. <br /> !illi!ii:ii!!i2iiiiuciiuii:!!'l5ii[ii!ui!!i-1^_114'kc45�Na"u(idiim'vac''V6l!IIiO!!LI!il!iillu!I!'u!L'u'iriiirN1i112111wiilia2i'ui:i+Lti!u5!110"i:!!14fiIGJ:YiIyOL-61NILJn!!W.d'din!:IIu:uW.II'rt <br /> EH 23 046 (Revised 9/11/96) Page 11 <br />