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SAN JOAQUIN COUN LIC HEALTH SERVICES - ENVIRONMENTAL HEAL�IVSION <br /> UNDEIJBMD STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY CONTACT NAME <br /> S FACILITY SITE NAME Aldo Fre alr0 <br /> I The Port of Stockton <br /> T SITE PHONE # with AREA COOS <br /> E FACILITY ADDRESS 2201 W. Washington St. (209)946-0246 <br /> $ STATE ZIP CODE # of TANKS <br /> CITY at SITE 1 <br /> A Stockton, CA 95203 <br /> P APPLICANT CONTACT NAME <br /> P APPLICANT/BILLING NAME SaCT38 �S above <br /> L The Port of Stockton <br /> I APPLICANT PHONE # WITH AREA CODE <br /> C MAILING ADDRESS <br /> A P.O. Box 2089 (209)946-0246 <br /> N STATE ZIP CODE TYPE of APPLICATION <br /> T CITY (Closure, installation, etc.) RetTlOVal <br /> Stockton. C�1 95213 <br /> TOTAL <br /> 198b 1987 1988 1 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 $ <br /> A <br /> C XXXX XXXX S <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) <br /> I $170/TANK (After January 1, 1991) <br /> V TANK FEE a 550.00/TANK (Prior to January 1,1991) <br /> E 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> # Tanks � <br /> F (muttiply # by fee for S <br /> A each year applicable) <br /> C S <br /> 1 TANK PENALTY FEES ASSESSED XXXX XXXX <br /> L <br /> I STATE SURCHARGE _ $56.00 each TANK (Due every 5 years) See California H $ S Code, Section 25287 <br /> T1991 through 1996 <br /> Y # Tanks x S56.00 1986 through 1990 <br /> (Enter amount and year) $ <br /> C PERMANENT CLOSURE (Remove( or Authorized Closure-in-Place) TANK I.D. #(s) <br /> L # TANK($) 1 X $234.00 s234.00 <br /> 0 CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) <br /> S TANK I.D. #(s) <br /> U TEMPORARY CLOSURE (Plan Review $ Inspections) <br /> R $234 : S <br /> E TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) # TANK(s) X .00 <br /> P INSTALLATION PLAN CHECK (Plan Review $ Construction Inspections) TANK T.D. #(s) <br /> L <br /> A . $624.00 minimum S <br /> H PLAN CHECK FEE _ $78.00/hour (8 hours minimum/FACILITY) <br /> RLREPAIR FEE (Workplan Review $ Construction Inspections) TANK I.D. #(s) <br /> E <br /> PLINING REPAIR FEE = $78.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00A = 5234.00 minimumTRETROFIT REPAIR FEE = 578,00/hour (3 hours min./FACILITY) <br /> R = 5234.00 minimum ; <br /> PIPING REPAIR FEE 578.00/hour (3 hours minimum/FACILITY) <br /> M TRANSFER FEE _ $20.00 UNAUTHORIZED RELEASE EVALUATION = S78.00/hr S <br /> S <br /> S = S78.00/hr S <br /> C CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE <br /> TOTAL DUE S2314,00 <br /> FOR OFFICE USE ONLY W•,- z-- �._— :,. �—:y :::::...., , <br /> --....— r-- -,._.....-.... _--� <br /> w... __............»......._..._....». nc-r..e... .»»u:u::�-_._...... --,.,_.c:._-Ln!_JJ..sie�!+�tw,;!S;;a!u,:l:,a.arui- �. �[... <br /> ?L�-'. . :i I !ri4iF§iF!ii! iifC•'!!si:sa!illio�-_u..u»i--is..l,�-::..... •-.--c .-:..._. <br /> !rtt. <br /> SWEEPS # COMPUTER # LOC CODE DIST CODE AMOUNT RECEIVED CK /CASH RECEIVED BY D TE RECEIVED -� <br /> € �- <br /> '_ .rn--r,n. r rremr�,! P:-:s;zaanm!ssn•putt. sa-cs,—••••x^•••-mr .... '"''"^ =n� !!i .r,u.........__i__..n....u.-..s <br /> . <br /> EH 23 032 (REVISED 11-1-92) Page 11 <br />