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SAN JOAQUIN COUll PUBLIC HEALTH SERVICES - ENVIRONMENTAL REAL )IK30M <br />UNDERINI = STORAGE TANK PROGRAM - FEE WORKSHEET J <br />S <br />FACILLTY SITE N <br />FACILITY CONTACT <br />I <br />TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) <br /># TANK(S) X 5234.00 = S <br />T <br />"E <br />FACILITY ADDRESS <br />SITE PHONE # with AREA CODE <br />M ILL <br />-TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) <br />= $234.00 minimum S <br />i <br />CITY1 <br />STATE <br />ZIP CODE # of TANKS <br />- <br />A <br />J IF��Ie-zvvl <br />at SITE <br />P <br />P <br /><9T/BILLING MANE <br />APPLICANT CONTACT NAME <br />L <br />�- <br />I <br />C <br />M <br />MA [NG AD S <br />_ <br />APPLICANT PHONE # WITH AREA CODE <br />8� <br />T <br />C TY <br />STATE ZIP CODE TYPE of APPLICATION �.� <br />A <br />r�� �,,.ow(Closure, <br />Installation, etC. )/ <br />PI INSTALLATION PLAN CHECK (Ptao Review 8 Construction Inspeetions)l TANK I.D. #(s) I <br />PLAN CHECK FEE a 578.00/hour (8 hours miniman/FACILITY) = $624.00 minimum I S <br />R <br />REPAIR FEE (Workplan Review 8 Construction Inspections) <br />TANK I.D. #(s) <br />E <br />P <br />TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) <br /># TANK(S) X 5234.00 = S <br />M ILL <br />-TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) <br />= $234.00 minimum S <br />R <br />1987 <br />1988 11989 <br />1990 <br />ANNUAL FACILITY FEE (Prior to <br />January 1, 1991) - 5100.00 <br />PXlll6x <br />A <br />X <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />S XXXX%XXX <br />C <br />T <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />XXXX <br />%XXX <br />XXX% I <br />XXXX <br />I XXX% <br />S xXX%%XXX <br />I <br />V <br />TANK FEE 550.00/TANK <br />(Prior to January 1,1991) <br />5170/TANK <br />(After <br />January <br />1, 1991) <br />E <br /># Tanks = <br />1988 <br />1989 <br />1990 <br />1991 <br />1992 <br />1993 <br />1994 <br />1995 <br />11996 11997 <br />1998 <br />F <br />(multiply N byby fee for <br />A <br />each year applicable) <br />XXX%XX%X <br />XXX% <br />XXXX <br />XXXX <br />5 <br />C <br />1 <br />TANK PENALTY FEES ASSESSED <br />XXXX <br />XX%X <br />XXXX <br />XXXX <br />XXXX I <br />I <br />I <br />S <br />L <br />I <br />STATE SURCHARGE FOR NEW FACILITIES ONLY -$18.50 <br />S <br />T <br />Y <br /># Tanks_ x 58.00 <br />1988 through 1993 <br />(556)1 <br />1993 through <br />1997 (556) <br />1 <br />1998 <br />XX%X%XXXXXXXXXXX%XXX)=X%XX <br />XXXXXXXXXXXXXXXXXXXXXXX <br />S <br />SURCHARGE FOR 1998 <br />PI INSTALLATION PLAN CHECK (Ptao Review 8 Construction Inspeetions)l TANK I.D. #(s) I <br />PLAN CHECK FEE a 578.00/hour (8 hours miniman/FACILITY) = $624.00 minimum I S <br />R <br />REPAIR FEE (Workplan Review 8 Construction Inspections) <br />TANK I.D. #(s) <br />E <br />P <br />TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) <br /># TANK(S) X 5234.00 = S <br />A <br />I <br />-TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) <br />= $234.00 minimum S <br />R <br />PIPING REPAIR FEE = 578.00/hour (3 hours minimm/FACILITY) <br />= $234.00 minimal S <br />I <br />TRANSFER FEE = 520.00 I 1 UNAUTHORIZED RELEASE EVALUATION = 578.00/hr I I i S <br />CONSULTATION FEE - 578.00/hr I I SAMPLING INSPECTION FEE = 578.00/hr I I I S <br />TOTAL OUE j S <br />FN ]; n;7 (RFVISFn 1-12-98) <br />