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SAN JOAQUIN COUNTY PUBLIC MEALiM SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEEI <br /> FACILITY SITE NAME FACILITY CONTACT MAME <br /> F <br /> r� _ <br /> I FACILITY DRES <br /> I SITE PHONE N with AREA CODE <br /> L�9 `G <br /> 1 CITY ,ATE hl`COJOf N of TANKS <br /> T 14 SJ.J eF f� et SITE <br /> AA APP�ANT/811 IND NiPE APPLICA TACT NAME <br /> C l DDRE93 © APPA CANT PRONE Y 4IT�A�REA C00 <br /> A Od �'E?-?":S7 <br /> N CITY TATE 2 CCOE TYPE of APPLICATION <br /> T (C�. ftf CLOSURE, INSTALLATION, *to. C/ <br /> A TOTAL <br /> C 1986 1987 1988 1909 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) $100.00 <br /> 1 <br /> V 5 <br /> E TANK FEE 550-00/TANK (prior to January 1,7991) 1170/TANK (alter Jaruery 11 1991) <br /> F N Tanks1986 1087 1088 1989 1990 1991 1992 199J 1994 1995 1996 <br /> A (multlply W y�ytee for <br /> C each yaar applicable) f <br /> L 5tATE SURCHARGE • S56.00 each TANK (Due every 5 years) $ee California 11 t S Code, Section 25287 1 <br /> I <br /> T Y Tanks s 556-DO 1906 through 1990 1991 through 1906 <br /> Y (enter i?55Mil t and year) _.._ <br /> f <br /> PERMANENT CLOSURE (Removal or Authorized Closure-In.Pl ace) TAMC I.D. Y(a) <br /> C <br /> L CLOSURE FEE $53.00 per hour (3 hours minlmulm per TANKI N TANK(s) X 5159.00 t 1SGY O <br /> G <br /> 5 <br /> U TEMPORARY CLOSURE (A one-tlme permit, for review/Inspectl ons) TAMC I.D. #(a) <br /> R <br /> E TEMPORARY CLOSURE FEE • $150.00 each TANK Y TANK(*) X 5150.00 .� f <br /> P <br /> L PLAN CHECK (Install. Plan Review 6 Construed on Inapactl ons TANK LD- Y(a) <br /> A <br /> N PLAN CHECK FEE - S53.00 per hour (8 hours minimum per Facility) • $424.00 minllmm 5 <br /> R REPAIR FEE (workplan review f construction Inspectlau) TANK I.D. $(a) <br /> F <br /> P TANK REPAIR FEE + $53.00 per hour (3 hours minimW TANK) N TANK(*) ,___ X $159.00 - i <br /> A <br /> _— <br /> per facility + 1150.00) <br /> R PIPING REPAIR FEE 553.00 per hour (3 hour minimum ...... <br /> 1 <br /> XTRANSFER FEE • S20.00 UNAUTHORIZED RELEASE EVALUATION . 553.00/hr 5 <br /> S <br /> C CONSULTATION FEE - 153.00/hr SAMPLING INSPECTION FEE • f53.00/hr S <br /> pp sp pI TOTAL DUE S <br /> �fi:f�y�immN115.A!�eQ§!Iglrnu11111nnmm�mmmminnnn nlnxn111u 11nm nnl 1 1101 In 1 mm�minnnnxnn In 11 Innm 00x1 xmumnnlnnlnn mlq 0110000 nmol nn lmmnnr. I nl�l• ! <br /> 1. IQ Q•IIQIIIQ I� QQ� � I 1...Imnml..uelnl Innnminit uJnnnmllulx <br /> a::'"1 1111 1'1..11111 11 1i 11'111 rllllll 111111:'i"I 1111111 II I 4 11 I 1111: II 11 I III I Illi III it 1:11111111 II 111 I:I I I ILII II ILII 1111111111111 III II' II III I YII I III IINI.a <br /> ��cA �4 ��w� <br /> illi IB��".IIp�111 I II(nmI��IIQIIII�III III n 011111 II II�II u 1 II nnn I IU �nu1011�1� Inl nn illi 1 n III 1 1YY111�1� II 1111111 11111 plllI''I Ix 1111111 I11n I 1 II mil 1111xry1111�11Y On nnm <br /> ' :: ::::1: .::::vm.i i:.ill:nl!i:li:l illl'IIIi1111111111�1.III�l 111111111.IIII116IIIIQIIII118IQI61IIIi IQI I I11111111Q111111111111111111 IQ11111111 QIII 11111111IIIQ QII III III IIIII�IQIIIIIII IIQIII 111:1111 IIIQI111111:ILII::III:IIIIIIIIIlI!Illllil:yiIIIIAYI t14'�:'nn'1Mil.'A if f:..115ii.:n11�Y:111111Ut1'.i�llxllll:x1'II' <br /> EM 23 032 (REV 4/8/91) it Page 11 <br />