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04 JOACUIN COUNTY PUBLIC HEALTH SERVICES 10 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> A Graphic Contractors Leon Warren <br /> C SITE PHONE # with AREA CLUE <br /> I FACILITY ADDRESS <br /> L 1325 West Weber Avenue 209 465-3380 <br /> ISTATE ZIP CCOE # of TANKS <br /> T CITY CA at SITE One <br /> Y Stockton, <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P Catellus Development Corporation Debbie Kirk <br /> L APPLICANT PHONE # WIT114REA CODE <br /> I MAILING ADDRESS <br /> C 201 Mission St. , 30th Floor 1 (415) 974-4544 <br /> A STATE ZIP CCOE TYPE of APPLICATION <br /> Closure <br /> RCIT(an Francisco, CA 94105 CLOSURE, INSTALLATION, etc. <br /> TOTAL <br /> r <br /> A 198 1987 798 1 89 1ff90 <br /> Cf <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 00 00 100 1{}0 �Lf <br /> I <br /> V <br /> E TANK FEE = `S50.00/TANK (prior to January 1,]991) 5170/TANK (after January , ]941] <br /> F # Tanks = 1 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (muttiply # by fee for <br /> C each year applicable) 50 50 50 50 150 170 420 <br /> Ii <br /> L STATE SURCHARGE = S56.00 each TANK (Due every 5 years) See CaLifornia H S S Code, section 25287 <br /> 11986 through 1990 1991 through 1996 <br /> T # Tank s_ x 556.00 <br /> Y (enter amount and year) $ 112 <br /> 56 56 <br /> PERMANENT CLOSURE (RemovaL or Authorized Ctosure-in-PLace) TANK 1.D. #(s) <br /> C <br /> L CLOSURE FEE = $53.00 per hour (3 hours minimum per TANK) # TARK(s)�� X 5159.00 S 159 <br /> 0 <br /> S <br /> [EE <br /> TEMPORARY CLOSURE (A one-time permit, for review 8 inspections TANK I.D. #(s) <br /> # TANK(s) X 5150.00 TEMPORARY�CLOSUREFEE 5150.00 each TANK <br /> P PLAN CHECK (Install. Ptan Review 8 Construction Inspections) TANK I.D. #(s) <br /> L <br /> A _ $424.00 minion S <br /> N PLAN CHECK FEE - $53.00 per hour (8 hours minimum per Facitity) <br /> TANK I.D. #(s) <br /> R REPAIR <br /> E <br /> P , TANK REPAIR FEE = $53.00 per hour (3 hours minimum/TANK) TANK(s) X 5159.00 = S <br /> A <br /> ! S <br /> R PIPING REPAIR REVIEW & CONSTRUCTION = 553.00 per hour (3 hour minimum per facility = $154.00) <br /> M CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> 7 TI <br /> S <br /> C FEE = 553.00/hr FEE = 553.00/hr FEE = S 53.00/hr d� <br /> TOTAL DUE s1,2 <br /> OFFICE USE ONLY .. <br /> .............•.....•..........•................ •••• 'l'a+ :.I.'{ T•f04`� �«.M?wl A,4 p.ip�al.�lowwlw�Awt� • <br /> ............................................ <br /> a� uu.•,r...:«+.•. wa...w.:oor»r } � �' r , K y...,ti:.:+<f .' so�vyl. + :A",`.:S Ski <br /> -�•. x';x'''.'Y w <br /> Ci 1C,LSH RC'/73'`9Y OdTt n��CeI�E�` 21 1 � <br /> flE s `otip "" bic coo <br /> DIST CGDE" At`10Utif` C g <br /> AW W"go w...s.. awWA 11U��i <br /> r <br /> Y...................... ... »+.•a»w.w�wr n..r.:wr:�a.+tt.vr ra r..n>s ++ <br /> „"`75' Swlf�tit fir'" ilfepY:1k7i 9ElLfi. 7BA�ti iiAf <br /> LIAR AmMW'iW Aug Wfgp7�l0iKfW�Ayib�l321i S0►XYiYlY=z i11Y«?�' w '..w..•..:•.,w...Lm i4.v..-::.::5 w;:y ,'+ fJi lln.� <br /> cu 71 nil /09V 17/7(,/4(11 f� Pl4n. 11 <br />