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SAN JOADUIN CCUNTY PUBLIC HEALTH SERVICES - ENVIRCNIIENTAL HEALTH DIVSIOH <br /> UWDERGROUMD STORAGE TANK PROGRAA - FEE WORKSHEET <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> 1 Crayfish International Thomas J. Olds <br /> T <br /> E FACILITY ADDRESS SITE PHONE R with AREA CODE <br /> s 8729 W. Walnut Grove Rd. N/A <br /> CITY STATE ZIP CODE 0 of TANKS <br /> A 5686 at SITE <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L Crayfish International Thomas J, Olds <br /> I <br /> C MAILING ADDRESS APPLICANT PHONE M WITH AREA CODE <br /> A <br /> N <br /> T CITY STATEZIP CODE TYPE of APPLICATION <br /> Thornton Ca (Closure, Installation, etc.) 1 <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) _ 1100.00 <br /> A f <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) KKKK KKKK f <br /> 1 <br /> V TANK FEE = 550.00/TANK (Prior to January 1,1991) 1170/TANK (After January 1, 1991) <br /> E <br /> R Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F (multiply N by fee for <br /> A each year applicable) -f <br /> C <br /> 1 TANK PENALTY FEES ASSESSED KKKK KKKK S <br /> I - <br /> I STATE SURCHARGE = 556.00 each TANK (Due every 5 years) See California H 6 S Code, Section 25287 <br /> T <br /> Y M Tanks z $56.00 1986 through 1990 1991 through 1996 <br /> (Enter amount and year) <br /> f <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK 1.0. #(s) <br /> L <br /> 0 CLOSURE FEE = $78.00/hour (3 hours minimm/TANK) M TANK(s)�_ K $234.00 = S 702.00 <br /> S <br /> U TEMPORARY CLOSURE (Plan Review b Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) 0 TANK(s) K $234.00 = f <br /> P INSTALLATION PLAN CHECK (Plan Review 6 Construction Inspections) TANK I.D. #(a) <br /> L <br /> A <br /> N PLAN CHECK FEE - S78.00/hour (8 hours minimum/FACILITY) = S624.00 minimus \_� f <br /> R REPAIR FEE (Workplan Review 8 Construction Inspections) TANK I.D. M(s) Q.Q <br /> E cc <br /> P TANK LINING REPAIR FEE _ !78.00/hour (3 hours minimum/TANK) N TANK(s) K S23�.NTx�l;\ \QN <br /> S <br /> A 0, <br /> I TANK RETROFIT REPAIR FEE - S78.00/hour (3 hours min./FACILITY) _ $234.00 minimus SpN NEPA 6F 'f <br /> R <br /> PIPING REPAIR FEE _ !78.00/hour (3 hours minimm/FACILITY) = $234.00 mini mum P �NME S <br /> M TRANSFER FEE _ $20.00 UNAUTHORIZED RELEASE EVALUATION = !78.00/hr f <br /> I <br /> S <br /> C CONSULTATION FEE 978.00/hr SAMPLING INSPECTION FEE _ $78.00/hr f <br /> % TOTAL DUE $ 702 00 <br /> FOR OFFICE USE ON LT77 <br /> _ .._. <br /> pi <br /> SWEEPS N COMPUTER M LOC CODE DIST CODE AMOUNT RECEIVED (IEC CASH RECE IVEO BY DATE RECEIVED 's <br /> EH 23 032 (REVISED 11-1-92) � <br />