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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES 9 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME <br /> F FACILITY CONTACT NAME <br /> A <br /> c Mid Val e Trailor Sales Hobe-,t Reer?u_- <br /> 1 FACILITY ADDRESS �- <br /> SITE PHONE # with AREA CODE <br /> L v 21 N W; lson ':'a 209 9 c• ^305 <br /> T CITY <br /> Y STATE ZIP CODE # of TANKS <br /> 3toclgon Ja oC Ca 9520 at SITE <br /> AAPPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P A A A Tam: ;removal ` Demo <br /> LL <br /> 1 MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> A �. .1 .-c, n ' 2.\;� itO Crit OY1 v3 ,!1<,, .,J <br /> N CITY <br /> T STATE ZIP CODE TYPE of APPLICATION <br /> -itn Cha O21 Ja 7 521 P CLOSURE, INSTALLATION, <br /> 1J'Ial <br /> A <br /> TOTAL <br /> C <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = 8100.00 1986 1987 1988 1989 1990 <br /> I <br /> V 8 <br /> E TANK FEE = 550.00/TANK (prior to January 1,1 91) 5170/TANK (after January 1, 1991) T <br /> F # Tanks = 1986 19871NIM 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply A—by fee for <br /> C each year applicable) <br /> 8 <br /> L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> 1 <br /> I # Tanks x $56.00 1986 through 1990 <br /> (enter 1991 through 1996 <br /> Y amount and year) <br /> S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> C <br /> L CLOSURE FEE = S53.00 per hour (3 hours minimum per TANK) # TANK(s) K $159.00 <br /> 0 = g00 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = $150.00 each TANK # TANK(s) K 8150.00 - <br /> 8 <br /> P PLAN CHECK (Install. Plan Review 8 Construction Inspections) <br /> L TANK I.D. #(s) <br /> A <br /> N PLAN CHECK FEE - S53.00 per hour (8 hours minimum per Facility) = 8424.00 minimum <br /> 8 <br /> R REPAIR FEE (workplan review 8 construction inspections) TANK I.D. #(s) <br /> E <br /> P TANK REPAIR FEE = 853.00 per hour (3 hours minimum/TANK) # TANK(s) _ K 8159.00 = g <br /> A <br /> I <br /> R PIPING REPAIR FEE = $53.00 per hour (3 hour minimum per facility = 8159.00) 8 <br /> M TRANSFER FEE = 820.00 UNAUTHORIZED RELEASE EVALUATION = 853.00/hr <br /> I 8 <br /> S <br /> C CONSULTATION FEE = 853.00/hr SAMPLING INSPECTION FEE = 853.00/hr <br /> 8 <br /> • TOTAL DUE 8 ,rte <br /> OFFICE USE ONLY 15 <br /> u'ae�ww»nv:av:ex"vzee»�eeiz»='am:='e:xo'iwmeieeo Haase�zeiooee:»ie»iez'eeieieeefe'e>»ieo:wee�:beoxeiee.(s'i»i:�e'ewe xeoiw�wn'e:io'ewe»i:ew:'oei,:xa'.xem. <br /> :axS "E `S " OPf ' 0 °'C ISG ' 1L7`aas ' E"C° / �` C' I) xsv` <br /> a R ramxwez� <br /> .......... <br />