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SAN !(ADMIN C TY PUBLIC HEALTH SERVICES - EINIRCNMENTAL HF' -H DIVS)ON <br /> L`AGROLIND STORAGE TANK PROGRM - FEE UORKSHEE, ., <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> I Stockton Steel Tom Juano <br /> - T <br /> E FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> 3003 E. Hammer Lane (209) 956-4751 <br /> a <br /> CITY STATE ZIP CODE 1 # of TANKS <br /> A Stockton I CA 95208 at SITE 4 <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L DECON Environmental Services, Inc. Sean Anderson <br /> i C NAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> s w 23490 Connecticut Street (510) 732-6444 <br /> 3 T CITY STATE ZIP CODE TYPE of APPLICATION Closure & installa ion <br /> Hayward CA 94545 (Closure, InstaLLation, etc.) (abovegroun ) <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 <br /> A S <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If AppLicable) XXXX XXXX S <br /> I <br /> V TANK FEE = 550.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> 1 <br /> 9 Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F (multiply #by fee for <br /> A each year applicable) 5 <br /> C <br /> I TANK PENALTY FEES ASSESSED XXXX XXXX S <br /> L <br /> I STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See CaLifornia H a S Code, Section 25287 <br /> 7 <br /> T # Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> (Enter amount 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 mininxWTANK) # TANK(s) 4 X 5234.00 = s 936.00 <br /> S <br /> U TEMPORARY CLOSURE (Plan Review a Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s)_ X 5234.00 = f <br /> P INSTALLATION PLAN CHECK (Plan Review a Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = 578.00/hour (8 hours minimWFACILITY) = 5624.00 minimum 5 <br /> R REPAIR FEE (workplan Review a Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE = 578.00/hour (3 hours minima /TANK) # TANK(s) X $234.00 = $ <br /> A <br /> 1 TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) = 5234.00 mini mm S <br /> R <br /> PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) = $234.00 minimum $ <br /> M TRANSFER FEE • 520.00 UNAUTHORIZED RELEASE EVALUATION - 578.00/hr 5 <br /> I <br /> S <br /> C CONSULTATION FEE = 278.00/hr SAMPLING INSPECTION FEE - 578.00/hr S <br /> TOTAL DUE S <br /> FOR OFFICE USE ONLY <br /> SWEEPS # COMPUTER # LOC CODE DIST CODE AMOUNT RECEIVED CHECK #/CASH I RECEIVED BY DATE RECEIVED <br /> a 5 <br /> EH 23 032 (REVISED 11-1-92) Page 11 <br />