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1 � <br /> SAN JOA0UIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND $IMAGE TANK PROGRAM - FEE YORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAIIE JACK DE WITT <br /> A DONALD J. CAMPBELL WESTERN METER SERVICE, INC. <br /> I FACILITY ADDRESS 412 W. WALNUT ST SITE PHONE 0 with AREA CODE <br /> L <br /> T CITYS1ATE ZIP CODE of TAMKf <br /> Y LODI CA 95290 .t SITE <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P Western Meter Service, Inc. JACK R. DE WITT <br /> P <br /> I MAILING ADDRESS APPLICANT PHONE IF WITH AREA CODE <br /> A 2735 TEEPEE DR, NE (209)948-612 <br /> CITY STATE ZIP CODE I TYPE of APPLICATION <br /> t STOCKJYJN CLOSURE, INSTALLATION, ate. <br /> TOTAL <br /> A <br /> T ANNUAL FACILITY FEE (PFlor to Jw*Ary 1, 1991) • $100.00 1986 1987 191!8 1989 7990 <br /> I $ <br /> E TANK FEE 550.00/TANK (prior to Jeruary 1,1991) 5170/TAMK (after Jewry 1, 1991) <br /> F e Tucks 1 1986 1987 7986 1989 1990 1991 1992 1993 1994 1995 1996 <br /> (sultlpty fee for <br /> each year app (cable) $ <br /> I <br /> STATE SURCHARGE $56.00 each TANK (Due every S years) fee California N i f Code, Section 25287 <br /> I <br /> / Tank■ x 556.00 1986 through 7990 1991 through 19% <br /> r (enter roast and year) <br /> S <br /> PERMANENT CLOSURE (Remove( or Authorized Closure-in-Place) TANK I.D. /(t) <br /> CLOSURE FEE • $53.00 per hour (3 hour$ minIuA per TANK) / TANK(e)__L_ K $159.00 • S 159.00 <br /> S <br /> TEMPORARY CLOSURE (A oro TAIL I.D. ! <br /> -tire permit, for revism/lrrpections) (a) <br /> TEMPORARY CLOSURE FEE • $150.00 each TANK IF TANK(s) ^ K $150.00 • f <br /> PLAN CHECK (Unite((. an Review i Construction Inspection) TANK I.D. f(a) <br /> a PLAN CHECK FEE - $53.00 per hour (8 hours minlass per Facility) • $424.00 alnisen S <br /> REPAIR FEE (workplan n <br /> review i cotrucn <br /> tlon Inspection) TANK I.D. 1(s) <br /> TANK REPAIR FEE • $53.00 per hour (3 houre ■InlamVIANK) 0 TANK(s) K $159.00 f <br /> t PIPING REPAIR FEE • 153.00 per houru(3 hour minimper facility • !159.00) f <br /> 1 TRANSFER FEE • 520.00 I111ALTIIORIZED RELEASE EVALUATION • $53.00/hr $ __ <br /> CONSULTATION FEE $53.00/hr SAMPLING INSPECTION FEE a $53.00/hr f <br /> TOTAL DU! f D <br /> yi;l Ir <br /> PS 8 COMPUTER 0 LOC COD11 DIST RECEIVED RT 11,119 <br /> I P-111 RE <br /> nn <br />[2332 (Revised 4/8/91) ►age 1t /' <br /> pw tr <br />