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BAN J(x1011IN COIMTY PUILIC HFAITH SERVICES - ENVIRONMENTAL HEALTH DIVSION <br /> UNnERPJ(tX)ND STORAGE TANK PROGRAM - FEE uGaKSIIEET <br /> LAltY SITE NaMF. FACILITY CONTACT NAME <br /> The Fannie Mae Frnlndation_ Darrell Isaacs <br /> TY ADDRESS SITE PHONE R with AREA COD! <br /> 25433 Eunice,Rd. <br /> 9TA E 21 A of TANKI <br /> �^– —�t _y �oDt et 5IT[ 1 <br /> -- —A� CA 95220 <br /> ANT/BILLING NAME —` -- <br /> APPLICANT CONTACTjWA <br /> _____ Fannie MaeFoundationDarrell IsaacsG ADDRESS APPLICANT PHONE • AREA CODE <br /> 7743 N. West Lane- Suite C 1 (209)235-STATE ZIP cc TYP! of APIdI <br /> Str,ekton. CA 9521(1 (cloture, latfon, etc.) Removal <br /> TOTAL <br /> ANNUAL FACILITY FEE (Prior to Janutary 1, 1991) v (100.00 1986 1987 1988 1989 1990 <br /> A <br /> C ____ xxxx xxxx xxxx xxxx xxxx s Xxxxxxxx <br /> T FACILITY PENALTY FEES A991991D (If Applireble) <br /> 1 X%XX XXX% xXXX xxXX X%XX f X%XX)tX%X <br /> E inRK FEE = 150.00/TANK (Prior to January 1,1991) 1170/TANK (After January 1, 1991) <br /> N Tanks 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1491 <br /> r (multiply W-Wfee for <br /> A each year appl(..ble) xxxx XXXX YXXX xxxx xxxx $ <br /> C <br /> 1 TANK PENALTY F1IS ASSESSED xxxx XXXX xxxx xxxX xItXX <br /> L <br /> 1 STATE SURCHARGE FUR NEW FACILITIES ONLY=518.90 <br /> Y ! tanks_ _ x sB.00 1988 through 1993-u(fS6) 1993 through 1997 (S%) 1990 <br /> SURCITARGE FOR 1998 X%NKXX%XX%XXXXXXX%xXXX%xXX( XXXXXX)DIX%%%XXxXxXXx%XX S $.00 . <br /> c vERNnNlMY CLOSURE (Removal or Authorized Closure-In-Place) TANK I.D. M(e)w <br /> O CI.OSIME FEE ' $78.00/hour (3 hours minimum/TANK) 0 TANK(s) 1 X 9234.00 . 1e34.00 <br /> U TEMPORARY CLOSUEF (Plan Review 8 Inspections) TANK I.D. R(a) <br /> F TEMPORARY CLOSORI FEE a 178.00/hour (3 hours minimum/FACILITY) $234.00 Minimum 9 I <br /> i <br /> I <br /> P INSTALLATION PLAN CHECK (Plan Review $ Construction Impectlont) TANK 1-D. M(s) <br /> L — <br /> M PLAN CHECK FEE • 08.00/hour (A hours minimum/FACILITY) • 3eZ4-00 ml nirTm <br /> R RF.PAIR FEE (Workplan Review $ Construction Inspections) TANK I.D. M(s) <br /> P TANK LINING REPAIR FEE = 178.00/hour (3 hours minimuR/TANK) $ TANK(w) x 9234,00 n f <br /> I TANK RETROFIT REPAIR FEE a 978.00/hour (3 hours min./FACILITY) • $274,00 minlnfaR <br /> R <br /> PIPING REPAIR FEE a 578.00/hour (3 hours minlmun/FACILITY) a 8234.00 minimum — I <br /> N TRANSFER FEE a *20.00 UNAUTHORIZED RELEASE EVALUATION . /78.00/hr <br /> I s <br /> C CONSULTATION FEE _ $78.00/hr SAMPLING INSPECTION FEE _ $78.00/hr <br /> TOTAL DUE '260.50 <br /> ft1R OFFICE USE ONLT <br /> T!TN!I!NIS !ii�lii!NNNINWIt4N ar,!p,pNflniili!:11911!INII6!P'p!IIII!fl!!�I„91!1!1!!II!li!fli.GIPUN'IiiUlNl�lfl!ilFa!!!Ilpfl�rypiN!!!p9NflIN!IN!N!INfl!N!iiill!!N!ilill!NNIIINNIN!!II�NIININNN!III!II�IUCNII�y�;IIIIIIIIIIiIIIIINIININiIx <br /> 44ElPS ! COHPUTER ! LOC COD$ DIST C60 ANOIINi RECEIVED CHECK !/CA9H <br /> ------ RECEIVED BY DATA pECFI VED <br /> ipMmm!;"NIINII�gnnaA pl�!!18!INNNNI!IINI! Nfl"t;.II9N!NIIIGN(6Nh"!NII1lrolit? P'klatifl�lllliN!P!N81lIHfP: IRillij Bll6 „. <br /> m Nr�INNNIflINNNNMNh11Nl✓[�mllNpl!!N�IN�IN!�Y NNN�IN�NI�" <br />