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4P0AOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> 7mocalBuelk <br /> FACILITY CONTACT NAME <br /> lant #0950 Chris McCaffrey <br /> A28135�Navy Drive sIr�2C x944 9115 E <br /> (I tockton ST6A 21§6�6i x of TANKS 2 <br /> at SITE <br /> A APPLICANT/BILLING NAME. APPLICANT CONTACT NAME <br /> P <br /> P Bassett Construction Inc. Rex H. Bassett <br /> L <br /> 1 NAILING ADDRESS APPLICANT PHONE x WITH AREA CODE <br /> C 7730 Greenridge Way ( 916 ) 967-7424 <br /> A <br /> N CITY STATE ZIP CODE TYPE of APPLICATION <br /> T Fair Oaks, Ca 95628 CA 95628 CLOSURE, INSTALLATION, etc. Removal <br /> TOTAL <br /> A <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) $100.00 <br /> I 5 <br /> Y <br /> TANK FEE • S50.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F I Tanks = _ 1966 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (mutd ply x by fea for <br /> C each year appticabte) S <br /> 1 <br /> L STATE SURCHARGE • S56.00 each TANK (Due every 5 years) See Catifornia H S S Code, Section 25287 <br /> 1 <br /> T x Tanks X 556.00 1986 through 1990 1991 through 1996 <br /> X (erlC of amoulG +nd yeaf) <br /> 5 <br /> FE.RMAN ENT CLOSURE (Reeovat or Authorized Ctosure-in-Ptace) I TANK I.D. x(s) <br /> CL05URE FEE • $53.00 per hour (3 hours minimum per TANK) 9 TANK(3) 2 % $159.00 = 15318 <br /> 1 <br /> J TEMPORARY CLOSURE (A one.-time permit, for review/inspec:f ors) TANK I.D. x(s) <br /> ' TEMPORARY CLOSURE FEE - 3150.00 each TANK x TANK(s) X $150.00 = S <br /> PLAN CHECK (Irstatt. Plan Review i Construction Inspections) TANK I.D. x(s) <br /> PLAN CXECK FEE 553.00 per hour (8 hours minieue per Facility) • S424.00 minimum 5 <br /> REPAIR FEE (workplan review d construction Inspections) TANK I.O. x(s) <br /> TANK REPAIR FEE - $53.00 per hour (3 hours miniaLWTANK) x TANK(s) X $159.00 = s <br /> PIPING REPAIR FEE = $53.00 per hour (3 hour minimum per facility - $159.00) S <br /> CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> FEE • 353.00/hr FEE 553.00/hr FEE = S 53.00/hr <br /> TOTAL DUE S 318 <br /> OFFICE USE ONLY <br /> .R1M•�s w +i im'w IS•� �rfitlL'a9 tis 'Y mis A'a9i <br /> i <br /> UO ° <br /> ... <br /> _....... <br /> _.._l..................... .........._.._.... ........_.............. ..=3_�.... l.. ?.tY...._... ` Y, z._ ... ._......_.......� <br /> rw r.rr,rrrrr rrw r,r rrrrr rwrrrrrr�wrr•rrrrr• rrsr wwrr+ rrrrrrr <br /> 5 032 (RE'! 1/10/91) ft Pace 11 <br />