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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVSION <br /> HNnERRRODNO STORAGE TANK PROGRAM . FEE NORKSIIEET <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> 1 Kelly Trucking Chuck Kelly <br /> T <br /> 'E FACILITY ADDRESS T SITE PHONE # with AREA CODE <br /> 4969 E. Waterloo Rd. (209)931-3038 <br /> CITY _ STATE ZIP CODE # of TANKS <br /> A Stockton , CA 95205 at 511E 1 <br /> P — --- - -- _—._ . . -- - --- - - -- - - -- -- - - ---- <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L Kelly Trucking Chuck Kelly <br /> I _----- --- - - <br /> C MAILING ADDRESS APPLICANT PHONE 0 WITH AREA CODE <br /> A 4969 E. Waterloo Rd. (209)931-3038 <br /> T CITY STATE ZIP CODE TYPE of APPLICATION <br /> Stockton, CA 95205 (Closure, Installation, etc.) Removal <br /> TOTAL <br /> 1986 1987 1986 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) s 5100.00 <br /> A xxxx XXXX xxxx xxxx xxxx E XXxxxxxx <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) xxxx XXXX xXxx xxxx xxxx E XXXXXYXX <br /> I <br /> V TANK FEE 350.00/TANK (Prior to January 1,1991) s170/TANK (After January 1, 1991) <br /> E <br /> a Tanks 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1098 <br /> F (multiply fl by fee for -,- --- <br /> A each year applicable) XX%% %XXX X%XX xx%x xxxx E <br /> C -- <br /> I TANK PENALTY FEES ASSESSED xxxx xxxx xxxx xxxx xxxx S <br /> t STATE SURCHARGE FOR NEW FACILITIES ONLY=$18.50 $ <br /> _-.-_-.-_—_-ov-gh.__—. — <br /> Y # Tanks x $8.00 1988 through 1993 TX <br /> 1993 througSIIRCIIARriE FOR 1998 Xx%XXXXXN%%xXXXx%XXXXX%X% xxxxXxxxxxxxxxxxxxxxxxx $ <br /> C PERMANENT CLOSURE (Removal or Authorized Closure•in•Ptece) TANK I.D. *(a)� 7 <br /> I. -- <br /> 0 CLOSURE FEE s $78.00/hour (3 hours minimum/TANK) If TANK(s)__J_ X 5234.00 = $ 2 34.00 <br /> S <br /> U TEMPORARY CLOSURE (Plan Review d Inspections) TANK I.D. #(s) <br /> E TEMPORARY CLOSURE FEE _ $78.00/hour (3 hours minimum/FACILITY) $234.00 minimus S <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspection$) TANK 1.0. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - 378.00/hour (8 hours minimum/FACILITY) _ $624.00 minimus $ <br /> R REPAIR FEE (Workplan Review & Construction Inspections) TANK 1.0. #(s) <br /> E <br /> P TANK LININO REPAIR FEE s $78.00/h6ur (3 hours minimum/TANK) # TANK(s) x $234.00 = f <br /> I TANK RETROFIT REPAIR FEE _ $78.00/hour (3 hours min./FACILITY) s $234.00 minimum f <br /> R <br /> PIPING REPAIR FEE $78.00/hour (3 hours minlssrrt/FACILITY) $234.00 minimum $ <br /> N TRANSFER FEE _ $20.00 UNAUTHORIZED RELEASE EVALUATION = $78.00/hr s <br /> --- — _ _ <br /> C CONSULTATION fEE 578.00/hr SAMPLING INSPECTION FEE $78.00/hr S <br /> TOTAL 011E 4 <br /> FOR OFFICE USE ONLY <br /> .::::::::. <br /> ......................:!I, .. ..._:...._ ..........u!:;.!;;nv_;!.._ ..3...... a........_:.n v..IRJn.11.11llltll rl ll. . ..i ........A............a.:^.en- r�:::a:::_=:::_:-:. :..-" <br /> ............._ r,r iL.�.........._�.....:......:...:....:r--�:,,..... :.�L.................._........ . L .!;.I;!;.;;a..___....-.�_:. ..i..... ......r ..I:m.i.l... ,,............,.,... <br /> .,.:•r,S ...:.._._._:.....!......:.:-..:Cr��:�:::.::::::::r::l��mm�,a�in:�nrll�a�,allnnc!lu�!n!!!ulil:F:�::r:.: -! _81G_.... ! I. ..! .! _W'Ri r:: IJII mil,.I .....:.... L.!1................— I! 1 tl..e.._...!.:I!::::I,.:.....r"::::_,:!!!:!:I!:�::...i.._.._,.,...6. �::!!!!�a!ill!�::a�!.al.:a:.adllnu.i.L!a.lulu:�l�ruu:rc;�;:;::: <br /> !!� <br /> SWEEPS k COMPUTER # LOC CODE 01ST CODE AHOUNT RECEIVED CHECK #/CASH REC ED 8Y DATE RECEIVED <br /> ' E <br /> ... :........ .,_;.... ... <br /> -..._.- nr.uillJl::�a::- li�:!:1.�:1!I,:::?IL!I�:,:. :mnNn1110.illllnllrnnlcllulm[In;mul aln::e):rla:IIIN1LOlif�ilh;;nG!IIOhT:h::!li!!!I!IIINiiI!iiiliili@li �I!!IdIL!!1I'rl:!8l d <br /> i4..1......d..Lili......I11N..@ LuHtlil._ill.!!IIuIIIM LIIhNIIlilllil <br />