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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM -FEE WORKSHEET <br /> FACILT CONTACT NAME <br /> I FACILIT SITE NAME r �/ <br /> T �U Lyon <br /> on/ / SITE PH E # w th AREA COD <br /> E FACILITY ADDRESS C / �� el '< <br /> I <br /> 76-S�O v�v STATE ZIP CODE # of TANKS / <br /> A CITY ^ e K �' S /3 at SITE CJ <br /> J, APPLICANT CONTACT WA <br /> P APPLI NT/BILLING NAME n,. � <br /> L C V -X1' 'EE (// Oy/1 .✓7i/L <br /> I APPLICAN PHONE # WITH AREA CODE <br /> C MAIy��D ESS _ OAak <br /> Q 9' 6 O 6 Z 7 <br /> M ATE P CODE PLICATION. <br /> T CITY lQ (,Cts , installation, etc.) <br /> TOTAL <br /> A TANK FEE = 550.00/TANK (Prior to January 1,1991) <br /> 5170/TANK (After January 11 1991) <br /> C 1986 1987 11988 1989 1990 1991 1992 1993 1994 1995 11996 <br /> T # Tanks = yy <br /> V eachtyea� applica6le)r XXXX %XXX XXXX XXX% %XXX I 5 <br /> E I S <br /> TANK PENALTY FEES ASSESSED %XXX XXXX XXXX XXXX XXX% <br /> S <br /> I STATE SURCHARGE = S56.00 each TANK (Due every 5 years) See California H d S Code, Section 2528 <br /> T 1986 through 1990 1991 through 1996 <br /> E # Tanks z 556.00 5 <br /> (Enter amount and year) <br /> C PERMANENT CLOSURE (Removal or Authorized CLosure-in-Place) I TANK I.D. #(s) S <br /> 0 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) % 5234.00 = <br /> 5 <br /> U TEMPORARY CLOSURE (Plan Review d Inspections) TANK I.D. #(s) 5 <br /> R <br /> E TEMPORARY CLOSURE FEE = 578.00/hour (3 hours miminimum/FACI CITY) I 5234.00 minimum <br /> P�INSTALLATIoN�PLANCHECK:(PLan� eview d Construction Inspections) TANK [.D. #(s)L S <br /> A = 5624.00 minimmNPIAN CHECK FEE = S78. hour (8 hours minimm/FACILITY) <br /> TANK I.D. #(s) <br /> RLTANK <br /> FEE (Workplan Review d Construction Inspections) 5 <br /> E <br /> PLINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) <br /> I # TANK(s) X 5214.0 = 5 <br /> A <br /> IRETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) = 5234.00 minimum5 <br /> R 5234.00 minimumG REPAIR FEE = S78.00/hour (3 hours minimum/FACILITY) <br /> M TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION <br /> = 578.00/hr I $ <br /> I 5 <br /> 9 = 578.00/hr _ <br /> C CONSULTATION FEE = 578.00/hr SAMPLING INSPECTION FEE <br /> TOTAL DUE <br /> —r____-- <br /> OF.f1SE_US.E_QN —.-- —__- <br /> - DaY'�r�2€IV[0 <br /> suE-Ps��'GMPu7�A-3"r�mC�t6 D s :a0`E-�AMcuNT��EIv�h�ri.HEtT-�TCA�it--�-a€�Elv <br /> EH 23 046 (Revised 9/11/96) Page 11 • <br /> • <br />