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SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES J <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGRCCFND STORAGE TANK PROGRAM - FEE UORKSHEET <br /> F FACILITY SITE NAME FACILITY CONTACT NAME <br /> A Nick Meintasis Ni k <br /> C <br /> I FACILITY ADDRESS SITE PHONE / with AREA CODE <br /> Ln <br /> 1 10606 E. Kimbely Dr 9&�)Q <br /> T CITY I ;TATE Z P CmF / of TAS <br /> Y Manteca, (.a 0 TAWS <br /> SITE <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P Nick Meintasis Nick Meintasis <br /> I MAILING ADDRESS APPLICANT PHONE 0 WITH AREA CODE <br /> Ci 10606 F. Kimberly Dr 821-5828 <br /> A <br /> I TYPE of APPLICATI <br /> T CITY Manteca .STA1E z19��6 CLOSURE, INSTALLATION, eto.Re(noval <br /> ld <br /> A TOTAL <br /> C 1986 1987 1 1988 1989 1 1990 <br /> I ANNUAL FACILITY FEE (Prior to January 1, 1991) • S100.00 pU 'Aev 16. /,!29 S SCS <br /> V <br /> E TANK FEE • S50.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F / Tanks • 1966 1987 1988 1 1989 1 1990 1991 '1992 1993 1994 1995 1996 -. . <br /> A (multiply Iy fee for <br /> each year applicable) l(XJ l�"J / O lJV 3 0 — ssJ-c/0.cx-, <br /> L STATE SURCHARGE • S56.00 each TANK (Due every 5 years) See California H L S Code, Sectlon 25287 <br /> 1 <br /> i I Tanks x 556.00 1986 through 1990 1991 through 1996 <br /> T (enter _amount and year) I I _ <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. I(s) <br /> C <br /> L CLOSURE FEE • $53.00 per hour (3 hours minia per TANK) / TANK(s) 1 X 5159.00 • S <br /> 0 <br /> S <br /> U IEMPCRART CLOSURE (A one-time permit, for review/impections) TANK I.D. /U)' <br /> R <br /> E TEMPORART CLOSURE FEE - $150.00 each TANK / TANK(s) X 5150.00 • IT <br /> P PLAN CHECK (Install. Plan Review L Construction Inspectfons) TANK I.D. I(a) <br /> Ll <br /> A <br /> N PLAN CHECK FEE - S53-00 per hour (8 hours minlm per Facility) • S424.00 minfm S <br /> R REPAIR FEE (workp(an review L construction Inspections) TANK I.D. /(s) <br /> E <br /> P TANK REPAIR FEE - S53.00 per hour (3 hours minim /TANK) / TANK(s) X 3159.00 • S <br /> A <br /> R PIPING REPAIR FEE = 553.00 per hour (3 hour mi ninon per facility a 2159.00) <br /> S <br /> M TRANSFER FEE 520.00 UNAUTHORIZED RELEASE EVALUATION • S53.00/hr S <br /> I <br /> C15 / <br /> CONSULTATION FEE 153.00/hr SAMPLING INSPECTION FEE T53.00/hr 3 / <br /> TOTAL DUE IT .-14 <br /> ..SGEEdS a�:re-�rO�ibUfR_(.. zmc+t .-CE. .a; f3fCC8'E. �uunGf)`�TCb,amm ``tITE `p���51 "x°wk ECIz�E608 —�u� IE'�� { <br /> a <br /> P .--��mirn-n 4^mrt-•Air'm��i im•m-x-mrr,. -t�� �a �lnrifr5�nmim(oF�.a.. <br /> .': -.a=�• ..iriA:nmarsn- FIIH!'.T.a.l'YLi4 ulYmmNyTinl.�uno-a�-�6'FnincLYUNW!'JMPtlXIdlmltl�iMJmlri1�19nv.�'M1m�iImMT�9^[i91!MMimipreme®nniiN➢T'1WMnuNYulY�e"`_----�.--"'--- <br /> EN 23 032 (REv 4/B/91) ft Page 11 <br />