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TAL <br /> SAN JOAWIM UNDERGROUND STORAGE STORAGER TANKVPROGRApr- FEE WORRKSHFE�LTNOSiON <br /> FACILITY CONTACT NAME <br /> FACILITY SITE NAME Tom Guido <br /> I Triple G.Produce <br /> T SITE PHONE R with AREA CODE <br /> E FACILITY ADDRESS (209)835-5123 <br /> 8690 Linne Rd. <br /> L STATE ZIP CODE R of TANKS 2 <br /> CITY at SITE <br /> A Tracy CA 53" 8 <br /> P APPLICANT CONTACT NAME <br /> P APPLICANT/BILLING NAME Same as above Same as above <br /> L <br /> I APPLICANT PHONE / WITH AREA CODE <br /> C MAILING ADDRESS <br /> A PO Hx 239 <br /> M STATE ZIP CODE iTPE of APPLICATION <br /> T CITY Tracy, CA 95378-023 (Closure, ITatallatien, etc.) Removal <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) ' 5100.00 % <br /> A 5 <br /> D xxxx xxxx <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) <br /> 15170/TANK (After January 1, 1991) <br /> V TANK FEE + 550.00/TANK (Prior to January 1,1991) <br /> E 1986 1987 19AA 1989 1990 1991 1992 1993 1994 1995 1996 <br /> R ientl ' 5 <br /> F (multiply R by fee for <br /> A tech year applicable) 5 <br /> C <br /> I TANK PENALTY FEES ASSESSED X%X% <br /> L <br /> ARGE ' 556.00 each LANK (Due every 5 years) see Califernle H 6 S Code, Section 2528 <br /> I STATE SURCH <br /> I 1986 through 1990 1991 through 1996 <br /> Y A tanksx SSb.aO 5 <br /> (Enter amount end year) <br /> TANK I.D. Itis) <br /> C PERMANENT CLOSURE (Removal or Authorized Clowre•in-Plaee) <br /> L p $234.00 ' S 468.00 <br /> R TANK(s)�_ <br /> O CLOSURE FEE • 578.00/hour (3 hours minimum/TANK) <br /> STANK 1.0. RU) <br /> U TEMPORARY CLOSURE (Plan Review 6 Inspections) • 5 <br /> $234.00 <br /> R <br /> E TEMPORARY CLOSURE FEE • 578.00/hour (3 hours minimum/TANK) R TANK(s)_ K <br /> P INSTALLATION PLAN CHECK (Pier, Review B Construction Inspections) TANK I.D. R(a) <br /> L 5 <br /> A 5624.00 minimum <br /> N PLAN CHECK FEE • 578.00/hour (8 hour minlPAm/FACILITY) <br /> R REPAIR FEE (Workplan Review 5 Construction Inspections) TANK I.D. R(a)ons) 5 <br /> E x 5234.00 <br /> P TANK LINING REPAIR FEE • 578.00/hour (3 hours minimum/TANK) R TANK(s) -- 5 <br /> A 5234.00 minimum <br /> I TANK RETROFIT REPAIR FEE • 578.00/hour (3 hours min./FACILITY) 5 <br /> pnam <br /> PIPING REPAIR FEE • 178.00/hour (3 hears minimum/FACILITY) • $234.00 mini <br /> R TRANSFER FEE • $20.00 UNAUTHORIZED RELEASE EVALUATION • 578.00/hr <br /> f <br /> 5 • 578.00/hr 5 <br /> C CONSULTATION FEE • 578.00/hr SAMPLING INSPECTION FEE <br /> TOTAL DUE S468.00 <br /> FOR OFFICE USE d1LT ,,,p�aa aml�a�nm.7 mnm'mm�J'ms, rami 'v! v! xuru' avii' <br /> ,mf Winn; m11411mn ruiC! 1^_9!11!^!JR�I''97 pi!!IpO!a!a JA3'i!L:S mIaGP141GJ tll lDax A P_^WxCBIa1L!0 ill <br /> • � <br /> SUE EPS R COMliltPUTER R LOC LODE DIST CODE AMOUNT` RECEIVED CHECK R/CASH RECEIVED BY DATE RECEIVE <br /> u 5 • <br /> iiI!nr.rm:^=��!. ... "m!n' .I mx.wxmu .m.aW!mnumnamme!mim!u... .h.m!manmImrein=aiawlm�vlm:mrla.a�.,.d�,c:uan_ncA..!.n.a-e..aOu- <br /> an2 - na>ru`.un' ':nm"MEa' m <br /> .aw� z•w <br /> I <br /> Page 11 <br /> EN 23 032 (REVISED 11-1-92) 0 I <br />