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SAN JOAQUIN COUNTY KATTC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVISION.A/ . <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FA JU TT CONTACT Hall <br /> 1993 <br /> lufIn K:3 a tx lil<«e ��( �G c it <br /> AL HEMI} <br /> E FACILITY ADORESISI // 1 SITE PHONE $.wit AREA C E J PERMIT/SEVICES <br /> t4-AJ Ir— <br /> CITY � TE ZIP CODEM of TANKS <br /> A -- �(_ C'O-i) [S [� at SITE <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L I / - <br /> A FLALING AD ESf APPLICANT PHONE Y WITH AREA CODE <br /> N <br /> a - I el <br /> i CITY 1 <br /> STAJE Z P CODE TYPE of APPLICATION �[ <br /> C{L A-3 r '{ (Closure, Installation, etc- alto <br /> TOTAL <br /> 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) • 1100.00 1986 1987 1988 <br /> W f <br /> f FACILITY PENALTY FEES ASSESSED (If Applicable) %%%% X%%% f <br /> 1 <br /> F TANK FEE _ $50.00/TANK (Prior to January 1,1991) 21701TANK (After January 1, 1991) <br /> Y Tanks 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F (multiply X by fee for <br /> t each year app(icable) S <br /> 1 TANK PENALTY FEES ASSESSED %%X% I %%X% S <br /> I STATE SURCHARGE • $56.00 each TANK (Due every 5 years) See California N i S Code, Section 25287 <br /> f <br /> ! N Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> ou <br /> (Enter amnt and year) <br /> S <br /> CI PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. M(a) -- ' <br /> L <br /> 0 CLOSURE FEE = 278.00/hour (3 hours minimum/TANK) M TANK(s)_ X $234.00 • S <br /> S <br /> U TEMPORARY CLOSURE (Plan Review L Inspections) TANK I.D. $(s) <br /> 4 <br /> E TEMPORARY CLOSURE FEE • 578.00/hour (3 hours miniasm/TANK) M TANK(s)_ X 5234.00 $ <br /> INSTALLATION PLAN CHECK (Plan Review i Construction Inspections) TANK I.D. $(s) <br /> t <br /> + PLAN CHECK FEE • $78.00/hour (8 hours minimm/FACILITY) • 2624.00 minimum S <br /> t REPAIR FEE (Workplan Review A Construction Inspections) TANK I.D. $(s) . <br /> TANK LINING REPAIR FEE • $78.00/hour (3 hours minimum/TANK) Y TANK(s) X 1234,00 • f <br /> 1 +nm <br /> TANK RETROFIT REPAIR FEE • $78.00/hour (3 hours min./FACILITY) • 5234.00 minimum S <br /> r PIPING REPAIR FEE 278.00/hour 0 hours miniaum/FACILITY) • $234.00 minimum S <br /> I TRANSFER FEE !20.00 UNAUTHORIZED RELEASE EVALUATION • $78.00/hr S <br /> CONSULTATION FEE • 178.00/hr SAMPLING INSPECTION FEE • $78.00/hr S <br /> TOTAL DUE f <br /> R OFFICE USE ONLY <br /> _ avx'm�. IIIIIam�aa. all <br /> �mm--tea <br /> SWEEPS N COMPUTER s LOC CODE DIST CODE AMOUNT RECEIVED CHECK M/CASH RECEIVED BY DATE RECEIVED a <br /> mn_smr mmmrn Miami <br /> r muss / <br /> Ir• <br /> 23 032 (REVISED 11-1-92) Page 11 !VI.^ 4 /) <br /> I <br /> .. r <br />