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0 COPY <br /> SAM JMDUIN UCOUNTY <br /> STOORAGEHEALTH <br /> TANKSERV <br /> PROGRAMENVHEALTH DIYSION <br /> FEE WMKSIEET <br /> FACILITY CONTACT NAME Charles Hauner <br /> S FACILITY SITE NAME <br /> I Bill Reich SITE PHONE A with AREA CODE (209)334-2354 <br /> E FACILITY ADDRESS 540 W Park Street <br /> A CITY STATE ZIP CODE atoSITENKS 1 <br /> A Lodi, CA 95240 <br /> P _____ APPLICANT CONTACT NAME <br /> l APPLICANT/BILLING NAME Charle auner <br /> B 1 1 Ru ch APPLICANT PHONE A WITH AREA CODE <br /> C MAILING ADDRESS <br /> A <br /> N STATE ZIP CODE TYPE of APPLICATION Removal <br /> T cTTr CA 5242 (closure, Installe[l on, etc.) <br /> Lodi rorAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 XX%x %Xx% <br /> AS vD <br /> C __ %%%% %%%% <br /> I FACILITY PENALTY FEES ASSESSED (If Arplicnble) 5)70/TANK (After Jnrwnry 1, 1991) <br /> 1 <br /> ESTATE <br /> LANK FEE = 550-00/TANK (Prior to Jnnunry 1,199 ) <br /> 1906 1987 1908 1989 1990 1991 1992 1993 1994 1995 1996 <br /> -ly A'pTy fee for xxxxXxXx 4f,nr applicable) ,�, 7SENALTY FEES ASSESSED %XX% XXX% %%%%SURCHARGE - 556.00 each TANK (Due every 5 years) see CalliornleAS code, Section 25287 <br /> 1986 through 1990 1991 through 1996 <br /> s 1 x 556.00 $112.00 <br /> ;mount and year) X X <br /> O PERIIAIIF.RT CLOSURE (Remova( or Authorized Closure-in-Pince) TANK I.D. A(s) 5234.00 <br /> ( _._.________------.—_--__ _—_— A TANK(s) X 5234.00 _ <br /> 0 CLOSURE FEE 578-00/hour (3 hours minim,;;/TANK) --�— <br /> S _._____ TANK I.D. A(a) T',tJUDI(r Ff = <br /> V TEHPDRARY CLOSURE (Plan Review A Inspections) <br /> R <br /> F TEMPORARY CLOSURE FEE = 178.00/hour (3 hours minimu!n/FACILITY) 5234.00 minimum /� D 0.J 'S 7 <br /> P <br /> IN <br /> PLAN CHECK (Plan Review L Construction Inspections) TANK LD. A(s) <br /> L <br /> A = 1624.00 mini mum 1 <br /> N PI.All P.IIECK FEE - 170.00/hour (0 hours mininKm/FACILITY) <br /> R REPAIR FEE (Workplan Review 6 Construction IMPections) TANK I.D. B(a) <br /> E TANK LINING REPAIR FEE = 178.00/hour (3 hours minimum/TANK) N TANK(s) __ X 5234.00 = 5 <br /> A S <br /> 1 TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) 5234.00 minimus <br /> R PIPING REPAIR FEE 178.00/hour (3 hours mini Thum/FACILITY) 1234.00 mini mum 5 <br /> 7M TRANsrER FEE = 120.00 UNAUTHORIZED RELEASE EVALUATION = 178.00/hr 5 <br /> 1 _ <br /> C CORSULIATION FEE 178.00/hr SAMPLING INSPECTION FEE 578,00/hr 5 <br /> TOTAL DUE .00 <br /> R.f. !nm mr.!nmilt!nn!mmmnu;;rennnmmm nnr!un!s?m!nmmmnnncmm�n:nm nmmn!n!;;inmmmmoinn!n1mmnin !m�n m�iTnm!i;,! � <br /> mlom!n�mnam dV'1 �ODE r ik!)"oUllf 'C�1V�D CNCICI�R � n .mm_ � �V � k ��� � <br /> n,!m nn!nmm�mm �nnn.im!�esen,m!mn.T.�.nnn!.urr <br /> nem!:m:mmu!mmimmn.a!eEnvanmumi !nmm,mmn mmmn!i�nnmim ue :vvimm��i�r!inimi�enilTi.!�r, !�ii.�!1Ti!!ilmgn'nnmid <br /> p: n!nn!!!s!mnunsm!n!!r!!een:mn..... !!non!:!!!e!!!!!.m!r!n!mmsnm!!!m!nn!.:!!!mm!m!e!!!!:o��n!!rram.r_a! <br /> EN 23 032 (REVISED 4-29-94) Page 11 <br />