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SAN JOAOUIN COUW-- PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEA DIVSION <br />:AID O(ND STORAGE TANK PROGRAM - FEE WORKSHEET <br />S <br />FACILITY SITE NAME <br />FACILITY CONTACT NAME <br />I <br />T <br />RTR FACTLTTY <br />PAT MERCURIO <br />E <br />FACILITY ADDRESS <br />SITE PHONE # with AREA CODE <br />a <br />5000 So. Airport Way <br />209 946-6310 <br />CITY <br />STATE <br />ZIP CODE <br /># of TANKS <br />AStockton <br />CA <br />95206 <br />at SITE 1 <br />I <br />P <br />APPLICANT/BILLING NAME <br />APPLICANT CONTACT NAME <br />L <br />1 <br />L <br />I <br />Tlq I) pt- of TranEzpnri-Af inn <br />Tony Rizzo <br />C <br />MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />A <br />N <br />10275 Old Placerville Rd. <br />916 551-3406 <br />T <br />CITY <br />STATEI <br />ZIP CODE I TYPE of APPLICATION C hoqure <br />Sacramento <br />Ca <br />95827 (Closure, Installation, a c. <br />TOTAL <br />A <br />C <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br />1986 1987 <br />1988 1989 1990 <br />xxxx xxxx <br />s <br />T <br />1 <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />%%xX xxxx <br />s <br />V <br />E <br />TANK FEE = 550.00/TANK (Prior to January 1,1991) <br />$170 'TANK (After <br />January 1, 1991) <br />F <br />A <br />C <br /># Tanks = <br />(multiply #Ty—fee for <br />each year applicable) <br />1986 1987 1988 1989 1990 <br />_ <br />1991 1992 1993 <br />1994 1995 1996 <br />xX <br />1 <br />L <br />TANK PENALTY FEES ASSESSED <br />%%%X XXXX <br />S <br />I <br />T <br />STATE SURCHARGE = S56.00 each TANK (Due every 5 years) See California H 8 S Code, <br />Section 25287 <br />Y <br /># Tanks x $56.00 <br />(Enter amount and year) <br />1986 through 1990 <br />1991 through 1996 <br />s <br />C <br />L <br />PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) <br />TANK I.D. #(s) <br />0 <br />S <br />CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) <br /># TANK(s) 1 X <br />5234.00 = <br />S 234800 <br />U <br />R <br />TEMPORARY CLOSURE (Plan Review 8 Inspections) <br />TANK I.D. #(s) <br />E <br />TEMPORARY CLOSURE FEE = 578.00/hour (3 hours mini mum /FACILITY) <br />SZ34.00 minimum <br />$ <br />P <br />L <br />INSTALLATION PLAN CHECK (Plan Review 8 Construction Inspections) <br />TANK I.D. #(s) <br />A <br />N <br />PLAN CHECK FEE = 578.00/hour (8 hours minimun/FACILITY) <br />= $624.00 minimum <br />S <br />R <br />E <br />REPAIR FEE (Workplan Review 8 Construction Inspections) <br />TANK I.D. #(s) <br />P <br />A <br />TANK LINING REPAIR FEE = S78.00/hour (3 hours minimum/TANK) <br /># TANK(s) X <br />$234.00 = <br />s <br />I <br />R <br />TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) <br />= S234.00 minimum <br />S <br />PIPING REPAIR FEE = S78.00/hour (3 hours minimum/FACILITY) <br />= $234.00 minimum <br />s <br />M <br />1 <br />TRANSFER FEE = S20.00 UNAUTHORIZED RELEASE EVALUATION = S78.00/hr <br />S <br />S <br />ClCONSULTATION <br />FEE = S78.00/hr SAMPLING INSPECTION FEE <br />= S78.00/hr <br />s <br />TOTAL DUE I S 234.00 <br />EH 23 032 (REVISED 10-28-93) Page 11 <br />