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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HP-LTH DIVSION <br /> 1' -RGROUND STORAGE TANK PROGRAM - FEE WORKSHE <br /> S FACI I Y ITE NAM FAC Y CO ACT N <br /> T -2 <br /> E FACI ITY ADDR S 51T <br /> SITE H E # ith REA ODE <br /> 8 <br /> CIT STATT ZIP CODE TANKS <br /> # of ,-n <br /> P at SITE L <br /> P APPLIC N BLL AM CANT CONTACT ANE <br /> L LS <br /> I <br /> C MAILING DRESS/ AP NT PH E # WI EA CODE <br /> A / <br /> N <br /> T CITY- TATEP LODE tYPE of APPLICA 101 <br /> (Closure, Installation, etc.) <br /> TOTAL <br /> 1986 1987 1988 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br /> 1989 1990 <br /> A 5 <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XXXX 5 <br /> I <br /> V TANK FEE = 250.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> # Tanks 1 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F (multiply y.fee for <br /> A each year appricabl e) $ <br /> C <br /> I TANK PENALTY FEES ASSESSED I XXXX XXXX $ <br /> L <br /> T STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California N 8 S Code, Section 25287 <br /> Y # Tanks X 556.00 1986 through 1990 1991 through 1996 <br /> (Enter a unt and year) <br /> S <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> L <br /> 0 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = 5 <br /> S <br /> U TEMPORARY CLOSURE (Plan Review 8 Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE - 578.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 = S <br /> L INSTALLATION PLAN CHECK (Plan Review 8 Construction Inspections) TANK I.D. #(s) <br /> A <br /> N PLAN CHECK FEE = 578.00/hour (8 hours minimm/FACILITY) $624.00 minimum 5 <br /> E REPAIR FEE (Workplan Review 8 Construction Inspections) TNK I. <br /> AD. #(s) <br /> P TANK LINING REPAIR FEE = 578.00/hour (3 hours minimm/TANK) # TANK(s) X 5234.00 = $ <br /> A <br /> I TANK RETROFIT REPAIR FEE = 478.00/hour (3 hours min./FACILITY) = S234.00 minimum 5 <br /> R <br /> PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) = $234.00 minimum S <br /> M11 TRANSFER FEE = $20.00 UNAUTHORIZED RELEASE EVALUATION = 578.00/hr S <br /> S <br /> C CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE = 578.00/hr S <br /> TOTAL DUE S <br /> :,:Fa(:::Q F;1:S�-4(.$sE, m:..gmai i._:..---......:,— !=r:raa�;i:,:. <br /> ........._......_... <br /> gI— <br /> ii::__:-:::...g.P._� �,....i _.;y ::.;R:; <br /> ,;; suEE6S #- � eDMour�R u �`7£DC-God DrsT c�ISE �'aMat,lir��c�rv��"� C11ECL�iC/0'A57� �a�cr:tv�d sv" �` DarE fiEc�IVEd � <br /> EH 23 032 (REVISED 11-1-92) Page 11 <br />