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to JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TAMC PROGRAM FEE WORKSHEET <br /> FACILITY SITE RAMS FACILITY CONTACT NAME <br /> T -I- F- DV P OtVNAPO <br /> FACILITY ADDRESS A, q SITE PIN)NE / with <br /> CITY C��//�oN T TE 2I► CODE a of TANKS <br /> J !t et SITE <br /> APPLICANT/$ILLING MANE APPLICANT CONTACT NAME <br /> MANNING ADDRESS / 1/ G nQ� APPLI�� PHONE �' TH AREA COOS <br /> CITY ly�b� Y (� /L !TATE 21P CODE TYPE of APPLICATION pp ,06vAL <br /> / A- CLOSURE, INSTALLATION, etc; l�-� <br /> IS <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) 3100.00 S <br /> TANK FEE 350.00/TANK (Prior to January 1,1991) 3170/TANK (after January 1, 1991) <br /> a Tanks 1966 1967 1988 1989 1990 1991 1992 1993 1 1994 1 1995 1 1996 <br /> eachtyear app l lCeble)r f <br /> STATE SURCHARGE • 556.00 each TANK (Due wary 5 years) See California N L S Code, Section 25287 <br /> S Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> (enter arrant wW year) S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in•Place) TANK I.D. f(a0 <br /> CLOSURE FEF $53.00 per hour (3 hours minimum per TANK) f TARK(s)__j_ K 5159.00 f A70 <br /> TEMPORARY CLOSURE (A one-time permit, for rwiw/Impact ion) TANK I.D. fO) <br /> TEMPORARY CLOSURE FEE • $150.00 asch TANK / TANK(s) X 5150.00 S <br /> PLAN CHECK (Install. Plan Rwiaw L Construction trrpactior, TAWC LD. fU) <br /> PLAN CHECK FEE - 353.00 per hour (6 hours minimum per Facility) • 5424.00 minium S <br /> IN <br /> REPAIR FEE (workplan review i construction inapactiom) TANK I.D. $(a) <br /> TANK REPAIR FEE • 553.00 per hour (3 hours minlmuyTANK) / iAMK(s) __ X $159.00 f <br /> PIPINO REPAIR FEE • $53.00 per hour (3 hour miniu per facility • $159.00) f <br /> SIR <br /> TRANSFER FEE $20.00 LKWTHONIMO RELEASE EVALUATION • $53.00/hr S <br /> CONSULTATION FEE • $53.00/hr SAMPLING INSPECTION FEE • $53.00/hr S - <br /> 70TAL DUE S/ <br /> Q- 0 <br /> a.t(.IR:R$& M8_ <br /> r .. "NP ...._ gCY <br /> . vo c— <br /> o .. <br /> 23 032 (Rwlsad 4/6/91) Pegs 11 53-0eA I U r ILI7�1 <br /> F <br />