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JO114 COUNTY PUBLIC HEALTH SERVICES J <br /> ENVIRONMENTAL HEALTH DIVISION <br /> U 101101114KOUND STORAGE TANK PROGRAM - FEE WORKSHEET• <br /> f^—FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> A Sierra Bay Farm Credit Service Eliot Appleton <br /> C <br /> I FACILITY ADDRESS SITE PHONE 0 With AREA CODE <br /> L 18775 Tom Paine Road <br /> I <br /> T CITY cT�1TE ZIP CODE / 4f TANKS <br /> T Tracy, FA at SITE 1 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> Sierra Bay Farm Credit Service Eliot Appleton <br /> I. <br /> I MAILING ADDRESS APPLICANT PHONE I WITH AREA CODE <br /> C P. 0. Box 8070 209 931-3770 <br /> A <br /> N CITY STATE21P CODE TYPE of APPLICATION <br /> r Stockton, CA 95208 CLOSURE, INSTALLATION, ate. Removal <br /> A Ag tank - exempt from back fees per Doug Wilson TOTAL <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) • $100.00 <br /> 1 ! <br /> v <br /> E YANK FEE • 150.00/TANK (prior to January 1,1991) $170/TANK (after January 1, 1991) <br /> F / Tanks • 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (MAtlply It by fee for <br /> c each year eppllcebl e) S <br /> I <br /> L STAIE SURCHARGE • 356.00 each TANK (Due every 5 years) See California N L S Code, Section 25287 <br /> 1 <br /> F R Tanks ■ 356.00 1986 through 1990 1991 through 1996 <br /> Y (enter rnotnt and year) <br /> f <br /> _PFOU" _ E (Removal or Authorized Closure-fn-Place) TANK I.D. IRs) <br /> L CLOSME. Egg',;: $53.00 per hour (3 hours mfnlmm per TANK) / TANK(s)--1— K $159.00 f 159.00 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for revf ew/Inspectlons TANK I.D. I(s) <br /> R <br /> E TEMPORARY CLOSURE FEE • 1150.00 each TANK M TANK(s) _ K $150.00 • f <br /> P PLAN CHECK (Install. Plan Review f Construction Inspections) TANK 1.0. /(a) <br /> L <br /> A <br /> N PLAN CHECK FEE • $53.00 per hour (8 hours minhnm per facility) • 5424.00 mini ! <br /> R REPAIR FEE (workplan revlew t construction fnspectfons) TANK I.D. I(a) <br /> E <br /> P TANK REPAIR FEE • $53.00 per hour (3 hours minfmm/TANK) / TANK(s) _ K $159.00 f <br /> A <br /> I <br /> R PIPING REPAIR FEE • 553.00 per hour (3 hour mfnfmre per facility • $159.00) S <br /> M CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> S <br /> C FEE $53.00/hr FEE + $57.00/hr FEE + f 53.00/hr <br /> TOTAL DUE f <br /> 159.00 <br /> OFFICE USE ONLY <br /> wisiw�si�wa�.a..r.m..airw�m�r'iyw iw"w"w.win rwrri�iiwmwarI"RrGiwxa"s�r,aAw,iwasiiii iIi�iw�wm�Isrra"rsFriiaiiIrm,aYaiwr,s'wmY�t�,iiai�r'iwsw,tmii�wrwwYrwwir'iiiiwi <br /> M"I•�f�U•r Ml IAtPV1eR • ltll: �Sf}ml�~ AmU1NI NNW 111t CK ■/ ASM Re LllVtu aT aaMw �i T��k�� % <br /> "w:ww:YA$w ""wiwAS:Yiwwwww�iwwrww�:wwwt:+4:'«w:fi::nw:Y:Y" :'www«iwt:Yww "rww'wwwwwwiw•»�r:a:ww:wwr»wi�. <br /> aie lml mlO Mm MNI mle mYM MIM mK MMaaMMmaMMMN MMM amN AImmM NamM ammramaMmm M/mWlPa pone aW maAM MMM mamMama am NMiaaMaameaamsmM+a MIIMMM MMI <br /> EN 23 032 (REV 1/10/91) It Pace 1 <br />