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SAM JOADIIIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL NEALTN DIVISION <br /> UN,"e,..eNO STORAGE TANK PROGRAM - FEE WORKSHEET <br /> — FACILITY CONTACT MARE <br /> FACILITY SITE NAME <br /> F Don Pelin CPM <br /> A Boettcher Western Properties 111 , Ltd. gt <br /> c SITE PNGNE 0 with AREA CODE N/A <br /> I FACILITY ADDRESS <br /> 4555 N. Pershing Ave. <br /> I STATE 21P CODE S of TANKS <br /> t CITY Ca. 95207 •t SITE 3 <br /> Stockton, <br /> A APPLICANT/BILlINO NAME APPLICANT CONTACT NAME <br /> r Don Palin CPM <br /> r Boettcher Western Properties 111 , Ltd. g� <br /> t APPLICANT PN(%1 NITy�Lg CODE <br /> I MAILING ADDRESS 850 W March Ln. (209 73194 <br /> f. <br /> STATE 21P CODE TYPE of APPLICATION - <br /> M CITY Ca. 95207 CLOSURE, INSTALLATION, ate-Removal <br /> I Stockton, . <br /> TOTAL <br /> A - 1986 1987 1988 1989 1990 <br /> C <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) • 5100.00 5 <br /> I <br /> v --- <br /> 5170 ANK (afteranua <br /> January 1, 1991) �l`R <br /> E TANK FEE = 550.00/LANK (prior to Jamary 1,1991) / <br /> r S Tanks • 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (MAtlpty F-Uy lee for S <br /> r each year appllcobte) <br /> 1pV <br /> t S/All SUNCNARGE • 556.00 each TANK (Doe every S years) See California HSS Code, Section 25287 ' <br /> –— 1986 through 1990 1991 through 1996 <br /> I / TerVc! N 556.00 <br /> r (enteranent end year) 5 <br /> PERMANENT CLOSURE (Removal or Authorized Closure-ln-Ptace) TANK I.D. N(a) <br /> C 5 47 <br /> L CLOSURE FEE • 553.00 per hour (3 hours minimae ler TANK) M— <br /> R0 <br /> % 5159.00 <br /> O <br /> 4 <br /> U TEMPORARY CLOSURE (A one-time Permit, for review/Inspeetlong) I.D. <br /> TANK(s) __ X 5150.00 = 5 <br /> E TEMPORARY CLOSURE FEE . 5150.00 each TANK <br /> P PLAN CHECK (Iretall. Plan Review 5 Construction Inspections) TANK I.D. NO) <br /> — <br /> t <br /> A5 <br /> N PLAN CHECK FEE - 553.00 per hour (8 hours minlmm per facility) = $424.00 mininem <br /> R REPAIR FEE (workplan review 6 construction Inspections) TANK I.D. R(a) <br /> f <br /> P TANK REPAIR FEE • 553.00 per hour (3 hours minletWTANK) 5 TANK(s) % $159.00 5 <br /> A <br /> I5 <br /> R PIPING REPAIR FEE = 553.00 per hour (3 hour miniam per facility • 5159.00) <br /> M CONSULfA1lON4 UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> S FEE = 5 53.00/hr <br /> C FEE • 553.00/hr FEE = 553.00/hr <br /> TOTAL DUE 5 <br /> OrFICEUSE ONLY ...... .............................. ......._......_............ ..../�........_.._.... _1 /I�_ <br /> ......__.._..... ......___ .+....... .................. w"ww' I1.lISH wIs NeC t'I VtU el •••�w•••wwilM wiA' wo- MRi iiM iw iw` <br /> all <br /> ..._...._ CW <br /> �w5wt ef'��ww rl'w wwwwr,aw�w�wwww OI SI CWE w�N1u/N1 N � • <br /> :• 5 �Ter aur -w�www <br /> ,ai,i'ili-w�G w�11II iTwr YS iiw www w,.iw ww www wwww www w�.nr.w wwwwwww wiw www ww •• w =W ll/Mw aaw <br /> M.~wM MMMIM aqM aM M anM fad Mea M w1M=eINYfIM IM tltla MY MM MIMM Aa 711 MM MY MTM 1M a11W 11M MMraM aW lMr mI lMIJ.M Iage MM MIa1M he <br /> IN 23 032 (REV 1/101911 It Pace 1 1 <br />