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SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> Cal-West Concrete Cutting Brick Joseph <br /> C <br /> I fACILIT ADDRESS SITE PHONE # with AREA CODE <br /> L 1' 53 Vanderbilt circle (209) 823-2236 <br /> i <br /> Y CITY Manteca SIpTE ZLPSGOpE ato51TTA <br /> ENKS t� (2) <br /> A APPLICANT/BILLING NAME -S3bAPPLICANT CONTACT NAME <br /> P <br /> P Alpha Geo Services, Inc_ Frank Hantedi <br /> L <br /> 1 NAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> G 298 Brokaw Rd_ (408) 988-1032 <br /> A <br /> N CITY Santa Clara STATE 21P CODE TYPE of APPLICATION <br /> T 95050 CLOSURE, INSTALLATION, etc. Closure <br /> A TOTAL <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) 5100.0(1 <br /> I S <br /> V <br /> E TANK FEE • 550.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F 9 Tanks 1986 1987 1988 1989 1990 1991 1992 1993 1994 1 1995 1 1996 <br /> A (multiply n byby fn for <br /> C each year applicable) S <br /> I <br /> L STATE SURCHARGE • $56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> I <br /> T # <br /> Ta x $56.00 1986 through 1990 1991 through 1996 <br /> Y (enter amolnt and year) <br /> S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-ln-Place) TANK I.D. #(s) <br /> C <br /> L CLOSURE FEE • $53.00 per hour (3 hours minimum per TANK) # TANK(s) 2 X $159.00 s 318.00 <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review $ inspections TANK 1.0. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE _ $150.00 each TANK # TANK(s) X $150.00 • 5 <br /> P PLAN CHECK (Install. Plan Review $ Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - 553.00 per hour (8 hours minimum per Facility) = $424.00 minimum $ <br /> R REPAIR TANK I.D. #(a) <br /> E <br /> P TANK REPAIR FEE • $53.00 per hour (3 hours minimum/TANK) # TANK(s) __ X $159.00 = S <br /> A <br /> 1 <br /> R PIPING REPAIR REVIEW i CONSTRUCTION • S53.00 per hour (3 hour mini mm per facility = $159.00) $ <br /> N CONSULTATIONS _ UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> S <br /> C FEE • $53.00/hr FEE • S53.00/hr FEE = S 53.00/hr <br /> TOTAL DUE S <br /> OFFICE USE ONLY <br /> ................................................................................................................................................................................................................................................................ <br /> :• L �•ate' �LO�"iT�` °�l�C�0 E' '�115F GCbE�'�"`A�IOUIISf RC�Varx: C ILASH� �tCG�)"x8�' '�i{ ���E���,'�f'�°�'•w+: <br /> • ]cL� A' yN ........_o.`.. <br /> oeaaa amemmismi- ��c�r'zac�xnnrzx�:za�:zsizia:ixinz�„xats,:u ;mrs a+ir,wawrw.iraiw awwr:sw.wrne,wi <br /> ru <br /> 17 n\9 iocv 1?/JA/0n1 rr Penn )1 <br />