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+ dip <br /> 0AN JOACBJfH COUNTY PUBLIC HEALTH SERVICES <br /> Ljti 7�D i ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE 'WORKSHEET <br /> TAStoc:kton <br /> CILIITE NAME FACILITY CONTACT NAME <br /> Transportation Refridgeration Rene Welsh <br /> CILITY ADDRESS SITE PHONE # with AREA CODE <br /> 4808 S. Hwy 99 (209)946-0648 <br /> 1 <br /> T CITY STATE ZIP CODE # of TANKS <br /> Y Stockton Ca. 95205 at SITE 2 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P Hiram Jewart Hiram Jewart <br /> P <br /> L <br /> i MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> C11200 N. Hwy 99 20 )931-1Z0, <br /> LT <br /> CiTY STATE ZIP CODE TYPE of APPLICATION <br /> Lodi Ca. 95240 CLOSURE, INSTALLATION, etc. Removal <br /> NT TOTAL <br /> FA <br /> tIECEIVE 986 1987 1488 1989 1990 <br /> FACILITY FEE (Prior to January 1, 1991} = 5100.0 <br /> V 4 19r92 S <br /> E TANK FEE = $50.00/TANK (prior to January 1,1991 TY <br /> �aAN JOA �}>:(R70jTATiA iter January 1, 1991) <br /> F # flanks = 1986 1987 1988 1T � L�A '1U 1994 1995 1496 <br /> A (multiply # by fee for <br /> C each year applicable) $ <br /> ffSTATE <br /> GE = $56,00 each TANK (Due every 5 years) See California H & S Code, Section 25287 <br /> $56.00 1986 through 1990 1991 through 1996 <br /> and year} <br /> S <br /> ETEMPORARY <br /> SURE (Removal or Authorized Closure-in-Ptace) TANK I.D. #(s) <br /> $53.00 per hour (3 hours minimum per TANK) # TANK(s) 2 x $159.00 = $318.00 <br /> SURE (A one-time permit, for review/inspections) TANK I.D. #(s) <br /> URE FEE = $150.00 each TANK # TANK(s) X $150.00 = S <br /> P PLAN CHECK (Install. Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minimum per Facility) = S424.00 minimum S <br /> R REPAIR FEE (workptan review & construction inspections) ETANK . #(s) <br /> P TANK REPAIR FEE = %53.00 per hour (3 hours minimum/TANK) ) x $159.00 = S <br /> A <br /> i <br /> R PiPING REPAIR FEE = $53.00 per hour (3 hour minimum per facility $159.00) $ <br /> M CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> S <br /> C FEE = S53.00/hr FEE _ $53.00/hr FEE = S 53.04/hr <br /> TOTAL DUE 318.00 <br /> OFFICE USE ONLY -- <br /> wa rose rosea oma momma oma xenaxeewa r0000.eae Mamea sweet wmooe xe.»mese»�aeipwe�o�eoeeo x.e xieacs xes been.was»a.xeees xee»mere�nese.xer»ane.�aeo:masse iee:+ri'e�nei wos seeee:�e'ea ie»wee»ieesieeei:ieu xaee6 w:i zoe»�+i:ias ieieei sage res: <br /> UMPUT ' ` tcL3 ' l fi SC G� `l�l � xE`L �l "�ea+ars�` �EIZr�fs <br /> ,r <br /> a...�6(0 +�� 0 i< L✓ $ i/ GCS // y� zf ?v, Y/Z- <br /> EN <br /> EH 23 032 (REV 1/10191) ft r <br /> waw»weeaawooeaemoew»wewewawmewewesMrzaroawwwmeee +emswmsaew'ei»cr'siwmeweeww«wmewww>...w..aro.aiu:wiiwwrowwrmwmewmwsr..wmwnuwmwe»reiwiii«niiw»�ueiwiMieis�iir'iwiiiSia'riiw dmaiiiwim <br /> fa�svuaemaszassars:�rebxaaa:�otxrtfre�:u� rux'e" �uxsmawwf�t:xwrfawsas�axerniaew�ursf��aafxviwr aatuxs�zuu:ra� fe�sm.�x:m�fr�uxfn>«snrf�e�+xsa�se� <br /> )7691, L� Paae i1 <br />