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SAN JOAoUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVSION <br /> UNT)ERGRCtJND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY CONTACT NAME <br /> S FACILITY SITE NAME Aldo Froggair0 <br /> I Port of Stocktorl <br /> T �. 3 U? Lti'1/ '& 5lTf PHONE # with AREA LODE <br /> E FACILITY ADDRESS 2201 W. Washington St. (209)946-0246 <br /> & STATE ZIP CODE # of TANKS <br /> A <br /> CITY Stockton, CA. 95201 at SITE 3 <br /> P APPLICANT CONTACT NAME <br /> P APPLICANT/BILLING NAME <br /> L port of Stockton <br /> I APPLICANT PHONE # WITH AREA CODE <br /> C MAILING ADDRESS (209)946—'0246 <br /> A P.O. Box 20139 Temp <br /> N STATE ZIP CODE TYPE of APPLICATION <br /> T CITY Stockton, CA. 95201 (Closure, Installation, etc.) Closure <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 # <br /> A # <br /> CXXXX XXXX <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) <br /> I5170/TANK (After January 1, 1991) <br /> V TANK FEE = S50.00/TANK (Prior to January 10991) <br /> E 1986 1987 1988 1989 1990 1991 1992 1093 1994 1495 1996 <br /> 9Tanks # <br /> F (,multip(y J! by fee for <br /> A each year applicable) S <br /> C <br /> I TANK PENALTY FEES ASSESSED XXXX XXXX <br /> L ears} See California H & S Code, Section 25287 <br /> I STATE SURCHARGE = $56.00 each TANK (Due every 5 y <br /> T 1986 through 1990 1991 through 1996 <br /> Y 0 tanks x $56.00 5 <br /> (Enter amount and year) <br /> #(s} <br /> C PERMANENT CLOSURE (Removal or Authorized Ctosure-in-Place) TANK I.D. S <br /> L # TANK(s) X $234.00 = <br /> 0 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) <br /> S TANK I.D. NO) <br /> U TEMPORARY CLOSURE (Plan Review $ Inspections) 5 <br /> R # TANK(s) 3 X $234.00 = <br /> E TEHPORARY CLOSURE FEE 578.00/hour (3 hours minimum/TANK) <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A5624.00 minimum S <br /> H PLAN CHECK FEE = S78.00/hour (8 hours minimum/FACILITY) <br /> R REPAIR FEE (Workplan Review & Construction Inspections) <br /> TANK L.D. N(s) <br /> E # TANK(s) X $234.00 = 5 <br /> P TANK LINING REPAIR FEE 578.00/hour (3 hours minimum/TANK) <br /> A $234.00 minimae 5 <br /> 1 TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) <br /> R ..................VA11111"FAE11111 .00 minimum 5 <br /> PIPING REPAIR FEE = 578.00/hour (3 hours min{mum/FACILIT <br /> M TRANSFER FEE 520.00 UNAUTHORIZED RELEAS UATI8.00/hr 5 <br /> I r _ <br /> 5pp t <br /> C CONSULTATION FEE = 578.00/hr SAMPLING iNSPEL'T HEALTI '� <br /> TOTAL DUE 702.00, <br /> •.rs:-:ra.•-:•r_+r..:r.:l:^'!°?:?»:^:n}^--nsa::.s::ae':rns}n:r:isl'i!? I.s+.!mm }!!-f!?}?FFC�!?[fnem!Ef??F9iElSn�!!FY:'•!ii3niz•',z! <br /> FOR OFFICE USE ONLY �_ _.....__.__ <br /> _._�...._..�....,ss::,::::.»s:ny...:-:::::::..:..............s....a::••:.:;..,......_:...... :rair.:::::a•s..»n::r.::isa::m�[+-,sss;}l?F•r=•iiS?3:ae:::sKOs__ii?inE!-_'-:ii}}Ls'.•.iieiL9 <br /> __ ..... ...r........rr.................r::::::i:;::2-:'?3ie""}}i'.:::::::.::::; .:.u:n........1.....,.....;;.lL.:. .............••,::-: r..:_ss,!'.n»;_:::x_ ss:;Y:_...........s.�.:....._._._.... RECEIVED <br /> ..... S�?:a3e!::z.;._..:•:: .n:::::_ss:e::::.:..:::::a::::::r.::::c::=::rr::: ::urssSiLz?i.EiEL°}"4!u"�ti::!iic:a::r_:w:u:: »._- Y DATE REC. <br /> ..in.,.u.... _ <br /> SWEEPS # COMPUTER # LOC CODE DIST CODE AMOUNT RECEIVED CHECK #/CASH RECEIVED n <br /> 7 ' (os g <br /> 5�JJ�4' !: !!If:!I:}nFl!!!a"rzss}`isrrrt+"!!?„ <br /> Jr v( -MME-Rill4s s �?"..s* ? ilii aii i.:is Ft u iicEJE s'sE: <br /> ...l; t-•np•rimijm '14 V11-4.t::W.1wo...f?Fm•m Ye F '.;"•))•I };,i,;v:s ns s - asss sort :m Cttlr•'n'13i��£"s:�'i';:.} r�.F:�tiaL:ns°"nSniliVniiE!} <br /> i:s i.I.ss s ! s:: n a <tsm rs::s: n ,; .atsus}tti',.,_:i4,.nillle�izilttl!ILiAatl3Jin4�3133£3§i'F 4---- <br /> :j}?:i.......:..i.L � Ie..it.... !..!sen..sg=.n�swm3n.-l:nenua.s---Iie= Lll1nnl�n�l.7i6• <br /> Page 11 <br /> EN 23 032 (REVISED 11-1-92) <br />