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SAN JOAOUIN COUMjY PUBLIC HEALTH SERVICE <br /> ENVIRONMENTAL HEALTH DIVISION <br /> r UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE MAHE FACILITY CONTACT NAME <br /> A Curtiss Pontiac, Cadillac , GMC, Inc. Joe poste <br /> C <br /> 1 FACILITY ADDRESS SITE PHONE N with AREA CODE <br /> L 2450 Toste Road 209 835-7750 <br /> a I <br /> =TAME of TAMK3 <br /> c"Tracy at SITE 3 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P Joe Toste <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE N WITH AREA CODE <br /> C <br /> A 2480 Toste Road 209 835-4476 <br /> N CIT STATE IIP CODE TYPE of APPLICATION <br /> Tracy CA CLOSURE, INSTALLATION, etc. Removal <br /> TOTAL <br /> A <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 11991) • $100.00 <br /> 1 $ <br /> V <br /> E TANK FEE a $50.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F N Tanks 21986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply Uby fee for <br /> C each year rppllcable) x X X x x x $ 840,00 <br /> L STATE SURCHARGE - $56.00 each TANK (Due every 5 years) See Callfornla N 9 S Code, Section 25287 <br /> 1 <br /> T N Tanks 2 . x $56.00 1986 through 1990 1991 through 1996 <br /> V (enter amount and year) <br /> x x $ 224 0 <br /> PERMANENT CLOSURE (Removal or Authorized Ctosure-In•Place) TANK I.Q. N(a) <br /> C <br /> L CLOSURE FEE - $53.00 ,per hour 0 hours minimum per TANK) N TANK(s)__3_ X $159,00 � S 477.00 <br /> 0 <br /> S <br /> it) IEMPORARY CLOSURE (A one-time permit, for review/Inspectlons) TANK I.D. N(s) <br /> R <br /> E 1EHPORARY CLOSURE FEE s $150.00 each TANK N TANK(s) x $150.00 + $ <br /> P PLAN CHECK (Instm(l. Plan Review A Construction Ingreetions) TANK I.D. N(a) <br /> L <br /> A <br /> H PLAN CHECK FEE - 153.00 per hour (8 hours minlmn per Facility) p 1424.00 minlmtrn ! <br /> R REPAIR FEE (workplan review b construction inspections) TANK I.D. N(s) <br /> E <br /> P TANK REPAIR FEE - $53.00 per hour (3 hours minimm/TAHK) N TANK(s) X ' 1159.00 $ <br /> A <br /> I <br /> R PIPING REPAIR FEE $53.00 per hour (3 hour minimum per facility ■ $159.00) $ <br /> H CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> 5 <br /> C FEE = 353.00/hr FEE . 153.00/hr FEE f 53.00/hr <br /> TOTAL DUE It 1 ,541 .00 <br /> OrricE USE ONLY <br /> �»r'i .:«ww"»Mrwi�w«w iww»w:wnw"iw:ii:Mw««wTiw:iiw.iw+w�wiM:»:iww.:ww»wwww :wi si�iu:r:iiw�«:►wwwwi«w"�i:w.:iiN t�Yw::wr: »wwrw.:ww:�w"::«»w»w»»w»w»ww» »M:: <br /> nrS aw s� �C�. `G ~*W " 1s�Lrn�E�I s <br /> $ <br /> s.......r............. .... ........................ .................... .............. ......... ................................. ......»............ <br /> ■riw .w rr ww r.► .»w.....N wu w..i■»■w..w..�M..». M«..»»rM..w..M»■..w w.rwdrw r+.w ru rru�ru M«w�w,�� N..�..wn.ra»..r rw w�wwww www wa.�r.►w <br /> �rrwr�+.e.wrf�wr�s�wfwrwR�MMhwf�wrl�erwv�rwwslwMr�l� wKAwwek��r�wwlAr�Maw��w�sswNw;YM►fwtfw� errf�weewAMwlMr�fYwl�w�w�rewwawwr <br /> [H 27 032 rREV 1/101911 ft Pace I 1 <br />