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- SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> F FACILITY SITE NAME FACILITY CONTACT NAME <br /> A PACIFIC PLUMBING A H MR. HARRY H. SHULER, JR. <br /> 1 FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> I <br /> ,cc �rATE Z # of TA <br /> Y JTOCKTON l q �i at SITNKS <br /> E ONE <br /> A APPLICAN,,T//BILLING NAME APPLICANT CONTACT NAME <br /> P HARRY H1 SHULER, JR. HARRY H. SHULER, JR, <br /> L <br /> C <br /> T`DDAWOR.A STREET APRkit6ANT4PHON Wi Tx AREA CODE <br /> A lLU7l OO ��U - <br /> NCITY ATE Z"j TYPE of APPLICATION <br /> T STOCKTON RCLOSURE, INSTALLATION, etc. CLOSURE <br /> A TOTAL <br /> C <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 1986 1 1987 1 1988 1 1989 1990 <br /> 1 5 <br /> - V <br /> E TANK FEE = S50.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F # Tanks = 1986 1987 1988 t 1989 1990 1 1991 1 1992 1993 1994 1 1995 1996 <br /> A (multiply 7- y—fee for <br /> C each year applicable) <br /> i I 5 <br /> I STATE SURCHARGE - $56.00 each TANK (Due every 5 years) See California H b S Code, Section 25287 <br /> T # Tanks x S56.00 1986 through 1990 1991 through 1996 <br /> Y (enter arrant and year) <br /> ) 2215 <br /> S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TA)K I.D. #(s) <br /> C <br /> LO CLOSURE FEE = $53.00 per hour (3 hours minimum per TANK) # TANK(s)� % 5 9 00 • s234.00 <br /> S <br /> R TEMPORARY CLOSURE (A one-time permit, for review/inspections) TAJK I.D. #(s) <br /> E TEMPORARY CLOSURE FEE - $150.00 each TANK # TANK(s) X 5150.00 = $ <br /> P PLAN CHECK (Install. Plan Review d Construction Inspection) TANK I.D. #(s) <br /> LlA <br /> N PLAN CHECK FEE - S53.00 per hour (8 hours minimum per Facility) a $424.00 minimum S <br /> R REPAIR FEE (workplan review S construction inspections) TANK I.D. #(s) <br /> E <br /> P TANK REPAIR FEE - $53.00 per hour (3 hours minimsa/TANK) # TANK(s) X $159.00 = S <br /> A — <br /> 1 <br /> R PIPING REPAIR FEE = S53.00 per hour (3 hour minima per facility - S159.00) S <br /> M TRANSFER FEE • 520.00 UNAUTHORIZED RELEASE EVALUATION = 553.00/hr $ <br /> 5 <br /> C CONSULTATION FEE = S53.00/hr SAMPLING INSPECTION FEE - S53.00/hr S <br /> TOTAL DUE S <br /> 2,226 nn <br /> __. QEf_LCI`USE QIiLY , <br /> -SUE�F.. ==I.WPOT Arlt ECEIVED —_ -- -- A'YE-kECF'IFEb�a <br /> EH Z3 032 (Revised 4/8/91) Page " <br />