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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH OIVSIOM <br /> UN- "4MM STORAGE TANK PROGRAM - FEE WORKSHEET <br /> IIFACILITY SITE NAME FAC(L' N E <br /> T <br /> 'EFACILITY ADOREG•�!G$e')S-/8_ SITE PHONE X • 'th AR <br /> A <br /> 1T <br /> CITY Z of TANKS <br /> A UYL at SITE <br /> P V <br /> PAPPLICANT BI ING NAME APPI CONT T AME <br /> L -e <br /> I <br /> C NAIL DDR 5 f j N7 P/fOtl��v <br /> iI•T<M-�! / / <br /> fes/ MPC J <br /> NTC !/� <br /> PLICATION <br /> I IT <br /> 7 ( lasur Installation, etc.) <br /> TOTAL <br /> 1986 11987 � 1988 7989 17990 <br /> ANNUAL FACILITY FEE (Prior :a January t, 1991) 5100.00 <br /> Al XXXX XXXX I XXXX XXXX I XXXX 5 XXXXXXXX <br /> C' <br /> TI FACILITY PENALTY FEES ASSESSE7i (If Applicable) XXXX I XXXX I XXxx I %XXX I x)cXX S xxxxxxxx <br /> I <br /> VI TANK FEE = 550.00/TANK (Prior ca lanuary 1,1991) I 5170/TANK (After January 1, 7991) <br /> EI I i I I I <br /> F (mulckPlY 3 by fee for <br /> 7988 1989 1990 1991 1992 1993 199 1995 1996 1997 1998 <br /> AI each year applicable) XXXX XXXX XXXX I XXXX I%XXX Ct <br /> I I 3 <br /> II TANK PENALTY FEES ASSESSED I XXXX I XXXX I XXXX I XXXX IXXXX I I I I I j I S <br /> L <br /> I STATE SURCHARGE FOR NEW FACILITIES ONLY=518.50 5 <br /> T <br /> Yl 9 Tanks_ x 58.00 1988 :hrcugh 1993 (S56) 1993 :hraugh 1997 (556) 1998 <br /> ISURCHARGE FOR 1998 I XXXXXXXXXX)DWXXXXXXXXXXXXX XXXXxxxxxxxxxxxxxxxxxxx I i S <br /> CI PERMANENT CLOSURE (Removal ar Authorized C.asure-in-PLace) TANK I.O. 9(s) <br /> L, I41 = <br /> O� CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) TANK(s)_ X 3234.00 5 <br /> S <br /> UI TEMPORARY CLOSURE (Plan Review 3 inspections) TANK [.D. SCSI <br /> R <br /> EI TEMPORARY CLOSURE FEE = 578.00/hour (3 hours minimum/FACILITY) I 3234.00 mini mum 3 <br /> Pi INSTALLATION PLAN CHECK (Plan Review S Construction Inspections) TANK I.O. :(s) <br /> L <br /> A <br /> M PLAN CHECK FEE = 578.00/hour (8 hours minimum/FACILITY) = 5624.00 mini mm S <br /> RI REPAIR FEE (UorkpLan Review 3 Construction Inspections) I TANK 1.0. d(s) <br /> E <br /> PI TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) I TANK(s) __ X 5234.00 ' 3 <br /> A <br /> I TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) = 5234.00 minimum 3 <br /> R <br /> I ?[PING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) = 5234.00 minimum 3 <br /> Ni TRANSFER FEE = 520.00 I I UNAUTHORIZED RELEASEE EVALUATION = 378.00/hr I I 3 <br /> CI CONSULTATION FEES = 578.00/hr I SAMPLING INSPECTION FEE = 578.00/hr I 3 <br /> TOTAL DUE S 3 <br /> FOR OFFICE USE ONLY --- -- <br /> 3 SLEEPS 3 COMPUTER x I LOC CODE I DIST CODE I AMOUNT RECEIVED CHECK -/CASH I RECEIVED RY DATE RECEIVED = <br /> i I <br /> EH 23 032 (REVISED 1-12-98) <br />