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BAN JINIOUIN COUNTY PIIELIC HEALTH SERVICES - ENVTRMWRIAL HEALTH DIVSION
<br /> IMFRCMMD STORAGE TANK PROGRAM - FEE VORKSNEET
<br /> S FACILITY SIZE NAMP FACILITY CONTACT NAME
<br /> T1 Van De Pol Enter rises Ron Van De Pol
<br /> -------- - -�-- -- -- -..
<br /> F. FAC11.1TY ADDRESS SITE PNONE N with AREA CODE
<br /> 3147 S. E1 Dorado St . (209)466-5921
<br /> CITY s)aTE iiv CODE N of TANKS
<br /> Stockton CA1 95206 at SITE 3
<br /> _huhu_ ......__
<br /> P APPIICANT/RILLINC PANE - - ---_-- --
<br /> L APPLICANT CONTACT NAME
<br /> Ron
<br /> Van De Pol
<br /> r.
<br /> MAIL IMO ADORl SS APPLICANT PHONE N WITH AREA CODE
<br /> A P.O. 1107 _
<br /> _ __ _ (209)466-5921
<br /> T CITY STAIE 21P CODE TYPE Of APPLICATION
<br /> (Closure, Installation, etch) Removal
<br /> TOTAL
<br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) 1100.00 1986 1987 1988 1989 1990
<br /> A
<br /> XXXX %XXX f XXXXXXXX
<br /> C ._-
<br /> t fnCILITY DENALTY FEE4 ASSESSED (If Applicable) %%%% X%XX %lo(Y %XXX f %%KX%X%%
<br /> I
<br /> V TANK, fig - 150,OD/TANK (Prier to January 1,1991) 1170/TANK (After January I, 1991)
<br /> E _
<br /> tl tanks 19118 1989 1990 1991 1992 1993 1994 1995 1996 1997 1098
<br /> F (multfply !��fee for
<br /> A !ach year applicable) X%xX XXXX XX%X XXX% NXXX f
<br /> C
<br /> I TANK PENALTY FEES ASSESSED KXXX X%X% XXX% X%%% XX%X f
<br /> L _
<br /> I STATE SURCIIAROE FOR NEW FACILITIES ONLY418.30 f
<br /> Y N Tankn__._ x fn-en 1988 through 1993 (156) 1993 through 1997 (S56) 1998
<br /> SURCIIAIME FOR 1998 XXXXXXXXX%XXXX%X%%X%%XX%%Xx X- XXX%%XXX%XXXXXXXX)(XX 1
<br /> C PERMANENT CLOSURE (Rem yM or Authorized Ctosure•fn-Ptacd YANK I.D. N(a)
<br /> JFr3nq RF. TEE 578.00/hour (3 hours minimum/TANK) 3N 1ANK(s)_ X 123<_00 0702.00
<br /> TEMPORARY CLOSURE (Plan Review A Inspections) TANK I,D. N(s)
<br /> TEMPORARY CLOSURE FEE • 178,00/hour (3 hours minfmun/FACILITY) $234,00 minlMen f
<br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK 1_0. N(a)
<br /> A 00 —�
<br /> M FLAN CNEGK Ft! • f)B.OD/hrnu (8 hours m(ninxan/FACILITY) . 5624-00 minimus 1
<br /> R REPAIR FEE (Workplan Review & Construction inspections) TARK I.D. N(s) .
<br /> .. ..huhi—
<br /> PLPINr
<br /> .._v TANK uNINO REPAIE FEE • R78.80/hear (7 hour! N1nlNlM1/1ANK) N TANK(s) ' % !234.00A T NK -- -.__. _FEE I TANK RETROFIT REPAIR FEE a 578.00/hour (3 hours min./FACILITYa1234,00 min(namR ___._-_.____REPAIR FFE - 1178.00/1jour (3 1101115 minlmuMIFACILIfT) - $234.00 minimus W
<br /> N TRANSFER FEE • 120.00 UNAUYNORIIED RELEASE EVALUATION . 278.00/hr
<br /> C C011SULIAIION IFF. + 178.00/hr SAHPLIfir. INSPFf(11UN FEE -e --
<br /> f78.00/hr g
<br /> TOTAL DOLE s 702 .00
<br /> FOR OFFICE USE ONLY
<br /> 0COMF
<br /> �.,;}::,:....is1.Cw::, r Afl: 1IfNl I!;)! I.iN:89 FIs°ILI�IINJi:alGlllhluf9!In!I, ni mFim . ;..nl:r ..
<br /> YI sutEPs r CONFUTER N JLI„11,116:x.helm!LII,JI!INEgIL�nI�uNaI�I�1Rrn(Ij!p!jj'i!j'�IL�wVI171I!ijlll(IIf�9j[Ciil!!14!iC!!!:gia!a p�;m !II'll!. vl�lll,!In n��•,,,,L:,
<br /> LOC COOL 01ST CODt I AMOUNT RECEIVED CNECK N/CASH RE'"iveo eiPoBll.�k,.JINNI„JI„J,',4t�uJI:N:9nJ6lll!6611116hJ�;q:!F
<br /> �I!11!7!IR'0,!'i'II,P IIIII I I 1 l Ill:lrnl I''•n min xnv ,p , ---fl}--
<br /> ��AxgJ1i q 1 Ip II�Ni11�!IgNgNI,IflPr,!' ;�,,,,;,,,41,,!i6,;7m,,,r ,, ,, ;,„u)4 r.�t1;PIiINNNIIiN(@NHNINi(!!�N(�glllli�NlNniNfiR!NiINNNINm!li!IIIN!IIN�ggpIIINIiIIIIIRIIIIINIINN IINN�11116'IU!H"'"
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