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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F General Potato S Onion Terry Cumberledge <br /> A <br /> L <br /> I FACILITY ADDRESS SITE PHONE 0 with AREA CODE <br /> L TT West Weber Avenue <br /> I <br /> T CIiTtOVS CktOR SCA ZIP CODE 9 of TANKS <br /> Y at SITE One <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P Catellus Development Corporation Debbie Kirk <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE B WITH-AREA CODE <br /> C 201 Mission St. , 30th Floor (415) 974-4544 <br /> A <br /> N CIT STATE ZIP CODE TYPE of APPLICATION Closure <br /> 1 do Francisco CA 94105 CLOSURE, INSTALLATION, etc. <br /> A _ TOTAL <br /> C 1986 1987 1 1988 989 11990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) a $100.00 _ <br /> 1 -- 00 100 <br /> V <br /> E TANK FEE _ '$50.00/TANK (prior to January 1,1991) $170/TANK (after January 1, 1991) <br /> F 7 Tanks : 1 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply Y by fee for <br /> C each year applicable) 50 50 50 50 1 50 1 170 s—q-2-0 SS <br /> L STATE SURCHARGE • $56.00 each TANK (Due every 5 years) See California H d 5 Code, Section 25287 <br /> 1 <br /> T S Tanks 1 x 656.00 1986 through 1990 1991 through 1996 <br /> Y (enter ammunc and year) <br /> 56 56 f <br /> PERMANENT CLOSURE (Removal TANK I.D.or Authorized Closure-in-Placa) k(s) <br /> L <br /> L CLOSURE FEE a $53.00 per hour (3 hours minimum per TANK) p TANK($) 1 % f159.00 • $ _ .5 9 j/ <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review d inspections TANK I.D. X(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = $150.00 each TANK 9 TANK(s) _ X $150.00 $ <br /> P PLAN CHECK (Install. Plan Review d Construction Inspections) TANK I.D. C(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - S53.00 per hour (8 hours minimum per Facility) _ $424.00 mini" $ <br /> R REPAIR TANK I.D. 4(s) <br /> E <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimum/TANK) A TANK(s) X $159.00 <br /> A <br /> 1 <br /> R PIPING REPAIR REVIEW 6 CONSTRUCTION • $53.00 per hour (3 hour minimum per facility = $159.00) 11L 1 9 <br /> M CONSULTATIONS UNAUTHCRIZED RELEASE EVALUATION SAMPLING INSPECTION 77Tff_ HEALTH - <br /> S <br /> C FEE _ $53.00/hr FEE = $53.00/hr FEE = f 53.00/hr <br /> TOTAL DUE $..)=-�-9} �0 <br /> OFFICE USE ONLY <br /> ' OEIPi ST'70 LOt4 # -L'g m,:1-s-rST'CCUEu" '"' 10"UIIY'ri CSO �CKECX 4/C.15�1' "r �iiC`iD"B'! `- D e-krc?L' Er mWRAY'4'•` s <br /> ..w.rraaa,rraewwaaxorwesssmas:ass:rAts.:vwxmaw ;:a:.;t.....;..,......,...x..i.,.,,,,»;:,.,o;.::.isass.»x.:.aasa �,nv usa iw+w mwaw wsrrrres�.+sw sr. <br /> - � Paan it <br />