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'PAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES 0 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY CONTACT NAME <br /> FACILITY SITE NAME Terry Cumberledge <br /> F1 General Potato & Onion <br /> A <br /> C SITE PHONE # with AREA CCOE <br /> I FACILITY ADDRESS <br /> L 1541 West Weber Avenue <br /> I STATE ZIP CODE # of TANKS <br /> YCITStockton CA at SITE One <br /> A APPLICANT/BELLING NAME <br /> APPLICANT CONTACT NAME <br /> PCatellus Development Corporation Debbie Kirk <br /> P <br /> L APPLICANT PHCNE # WITH-AREA CODE <br /> I MAILING ADDRESS <br /> C 201 Mission 5t. , 30th Floor (415) 974-4544 <br /> A STATE ZIP CCAE TYPE of APPLICATION Closure <br /> N CIT�an Francisco CA 94105 CLOSURE, INSTALLATION, etc. <br /> T <br /> TOTAL <br /> A ('1988 1989 1990. <br /> C <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) 5100.00 0 0 0 5 <br /> E <br /> V <br /> E TANK FEE _ `550.00/TANK (prior to January 1,1991} ;$170/TPANK (afterJanuary 1, 1991) <br /> F # Tanks = l 1986 1987 1988 1989 L501a � <br /> 1991 1993 1994 1995 1996 i , <br /> A (multiply # by fee for $ 420 <br /> C. each year applicable} 50 50 50 50 70 <br /> E <br /> Sae California H & 5 Cade, Section 2528 <br /> L STATE SURCHARGE = 556.00 each TANK (Due every 5 years) <br /> 11986 through 1990 1991 through 1996 <br /> T # Tanks l x $56.00 <br /> Y (enter amount and year) 56 56 S 112 <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Piace) TANK I.D. #(s) „ <br /> C $53.00 CLOSURE FEE = 553.00 per hour (3 hours minimum per TANK) # TANK(s) 1 X $154.00 = 159 <br /> $ <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review 8 inspections TANK I.D. (s) <br /> R # TANK(5) X 5150.00 = $ <br /> E TEMPORARY CLOSURE FEE = $150.00 each TANK <br /> P I PLAN CHECK (Install. Plan Review & Construction Inspections} TANK E.D. #(s) <br /> L <br /> A = S <br /> N PLAN CHECK FEE - S53.00 per hour (8 hours minimum per Facility) $424.00 minimum <br /> TANK I.D. 4(s) <br /> R REPAIR <br /> E # TANK(s) X $159.00 = S <br /> P TANK REPAIR FEE = 553.00 per hour (3 hours minimum/TANK} <br /> A <br /> I $ <br /> R PIPING REPAIR REVIEW 8 CONSTRUCTION = 553.00 per hour (3 hour minimum per facility = $159.00) <br /> M CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I a <br /> S FEE = S53.DOIhr FEE = 5 53.00/hr <br /> C FEE = S53.00/hr <br /> TOTAL DUE 9-- <br /> =;Xz' .00 <br /> OFFICEUS€ ONLY ............ ....................] n4�w `' j'"�C`OMP 'hoc COtlFDiST"CCDE ai'teUllr rri3 C Eex /C(SH Re'TJ 9Y DAT '"� C [°;1E reZ I '� <br /> $ II��`� l_ .-. ..�• <br /> .C:a:^c::ae!. :a:a:. «:«s>-e � ..,.,• :1«a.vw�is......r J.:.J.p.�... •�......ra..s::.�i.»i.+iw.i:.+w <br /> �................ ... ..••jey,:swiw:.�•• ievninwi��.....vwia,<°xc�:��::01'::f:X:. <br /> "W <br /> e:u ;:a4:.vxa.�...r,.................�..........: <br /> um AWAi AS 9+mjY ps rx?.'^i;>7Y sM:»5%:YiiiY <br /> A71iAR 90NIli rl7i�MV�A101i .. <br /> Pea �1 <br /> cu 71C n" 10cw i9/7A1gA1 it <br />