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UNDERGRO.M STORAGEATANKTPROGRAM '- FEE WORKSHEET ._ <br /> FACILITY CONTA_06 <br /> Uc <br /> The Port of Stktorl Aldo Fre ai <br /> RESS SITE PHONE # with AREA CODE <br /> 2201 W. Washington St. (209)946-0246 <br /> iT , STATE ZIP CODE I of TANKS <br /> Stockton, CA 95203 at SITE 1 <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L The Port of Stockton Same as above <br /> 1 <br /> C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> A P.O. Box 2089 (209)946-0246 <br /> N <br /> T CITY STATE ZIP CODE TYPE of APPLICATION <br /> Stockton CA 85213 {Closure, Installation, etc.) Removal <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) $100.00 1 <br /> A <br /> C 5 <br /> XXXX XXXX <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) <br /> i <br /> V TANK FEE - 550.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> N Tanks 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F (multiply 0 by fee for <br /> A each year applicable) 5 <br /> C 1 <br /> I TANK PENALTY FEES ASSESSED XXXX XXXX <br /> L <br /> 1 STATE SURCHARGE ! $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 <br /> T <br /> Y N Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> (Enter amount and year) <br /> S <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> L <br /> 0 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) N TANK(s) 1 X 5234.00 s t234.00 <br /> S <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. 0(s) <br /> R <br /> E TEMPORARY CLOSURE FEE ■ S78.00/hour (3 hours minimum/TANK) TANK(s) X $234.00 • 5 <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE w 578.00/hour (8 hours minimum/FACILITY) 1624.00 minimum 5 <br /> R REPAIR FEE (workp(an Review & Construction Inspections) TANK I.D. 0(s) <br /> E <br /> P TANK LINING REPAIR FEE ■ 978.00/hour (3 hours minimum/TANK) # TANK(s) X 1234.00 f <br /> A <br /> I TANK RETROFIT REPAIR FEE : 578.00/hour (3 hours min./FACILITY) ■ $234.00 minimum 5 <br /> R <br /> PIPING REPAIR FEE m S78.00/hour (3 hours minimum/FACILITY) ! 1234.00 minimum 5 <br /> M TRANSFER FEE a 520.00 UNAUTHORIZED RELEASE EVALUATION - 178.00/hr 5 <br /> I <br /> S <br /> C CONSULTATION FEE a 578.00/hr SAMPLING INSPECTION FEE : $78.00/hr <br /> TOTAL D �.0O <br /> FOR OFFICE USE ONLY <br /> �5 i _. Nr •t�••i,rs:• "ss{:•n':rtgi a?s i•"!i!'i°' ES3aT. ?.... i !'nl^J!£!s]'g^`r<fillli4K�{t!tl... .. (fa.44'�'It'i1PR {RRS!!'10X11m'fIf!ti it!Tu <br /> itq. <br /> .s..u:°"'v!!!*�E?o11tlI11iFL:i1^_!!NeTi?fi'E,?kF €?is,s_T-�as.:._s_s�?5��-._.-u.r.......a.,.T-pn..� .x..i..?Ln?i"fl-1—M---mi•' s�,.i-• �5. _.S.L_'[33E1!! CaiiiHlihLN.Lt!4tk�'.. <br /> a <br /> SWEEPS # COMPUTER # LOC CODE DIST CODE AMOUNT RE_E VED CHECK, /CASH RECEIVED BY DATE RECEIVED <br /> 5 <br /> '::�J�'......,.,.^.L'L•Qe"^.'•._'.t_!'.t.n.SI!L�_[�.n.«M,^... ^..1Q!Iu.!��]'!1!L�ittJ'll�...a=�. ...CJ.'-."i:^.ln�'l::»:-« »L.i«..^.i.:_�..i -__i•n�-im'6.:..:u .n.s.s....e•�.i..-.«.s:sgaxL•_•.".:i._a-�i.nq=j 131p7 S . / d'.a.s'!.-ir�r7_'n tiLrc.s:tssryattqu:.`i.r <br /> .Le_xssi.i.ssi!:s.•.ic.3p <br /> I <br /> EH 23 032 (REVISED 11-1-92) Page 11 <br />