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SAN )�JeQUIN COUNTY ENVIRONMENTAL HEALTH DN4(RTMENT <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> FACILITY NAME FACILITY CONTACT NAME <br /> John Taylor Fertilizer (Stockton Facility) Eric Jenks <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 1819 South Argonaut, 916 ) 991-9813 <br /> CITY STATE ZIP CODE I #OF TANKS AT SITE <br /> Stockton CA 95206 1 1-12,000 gal.split <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Ramcon Engineering&Environmental Contracting,Inc. Rollo Stephens <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> PO Box 1026, -7$-2S� <br /> CITY I STATE I ZIP CODE CIRCLE WORK TO BE DONE: <br /> West Sacramento CA 95691 ®Closure[]installation[]RepairORetrofit <br /> ACTIVE FACILITY <br /> 1997-1999 2000 2001 2002 <br /> $500 FEE INCLUDES FACILITY FEE+ 1 TANK ($170)x(0nera)x(#olmla applicaw) <br /> $125 PER TANK AFTER FIRST TANK <br /> $ <br /> TANK PENALTY ASSESSED <br /> TANK SURCHARGE=$10/TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$17.50/FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID#(s): Unknown- 1 tank CLOSURE FEE=$267/TANK I #TANKS X$267= $ 267.00 <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID#(s): TEMPORARY CLOSURE FEE=$267/FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections <br /> TANK ID#(s): PLAN CHECK FEE_$712 I FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <br /> TANK LINING REPAIR FEE=$267/TANK #TANKS X$267= $ <br /> TANK RETROFIT REPAIR FEE_$267/FACILITY <br /> PIPING REPAIR FEE _$2671 FACILITY <br /> MISCELLANEOUS <br /> TRANSFER FEE _$20 <br /> CONSULTATION FEE _$89/HOUR <br /> UNAUTHORIZED RELEASE EVACUATION FEE - $89/HOUR <br /> SAMPLING INSPECTION FEE _$69/HOUR <br /> ALL FEES ARE BASED ON THE$99 HOURLY RATE.TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST M I FACILITY ID AMOUNT RECEIVED I CHECK# I RECEIVED BY I DATE RECEIVED <br /> SIR <br /> EH 23 032(REVISED 3115102) <br />