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SAN JOADUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE UORKSHEET <br /> FACILITY CONTACT NAME Gl <br /> FACILITY SITE NAME <br /> A �v 1151 CaL.teti MlrJrc s� itcs2 W74i—r <br /> IL�tocs , RG . � <br /> C SITE PHWE # with AREA CODE <br /> 1 FACILITY ADDRESS q- <br /> L # of TANKS <br /> 1 �^ TE ZIP CODE at SITE ��� <br /> T CITY ���,./� W 71 - ��7 <br /> Y 3—jbc' <br /> APPLICANT CONTACT NAME <br /> A APPLICANT/BILLING NAME _ p <br /> P G I S 'f Po 9 U e— 6—)IL's Wr4-t.7 <br /> ivZC1-i.o r� P', d <br /> L APPLICANT PHON # WITH AREA ODE <br /> 1 MAI I,ICr DRESS L p� ^ � <br /> A 4' ✓(� STATE Z ODE TYPE of APPLICATION GL�„su/t-2 <br /> T CITY �6C IL�p _ S'L25 I CLOSURE, INSTALLATION, etc. <br /> TOTAL <br /> A 1986 1987 1988 1989 1990 <br /> C 1991) = 5100.00 f <br /> T ANNUAL FACILITY FEE (Prior to January 1, <br /> V 1991) 5170/TANK (after Jenuery 1, 1991) <br /> E TANK FEE 550.00/TANK (prior to January 1, <br /> 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F # Tanks = f <br /> A (m.i(tiply Wfee for <br /> C each year applicable) <br /> I <br /> L STATE SURCHARGE - S56.00 each TANK (Due every 5 years) See California H1& S Code, Se991 through itib 2528 <br /> I 1986 throWh 1990 <br /> T # Tanks_ x 556.00 S <br /> Y (enter amount and year) <br /> PERMANENT CLOSURE Removal or Authorized Closure-in-Place) TAxKTD. #(s) 5 Z 34 <br /> L CLOSURE FEE - SB3.00 per hour (3 hours minimumper TANK) # TANK(s) °Iu - % f 0 <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review/i nspecti ors) TANK I.D. (s) S <br /> R # TANK(s) _ % 5150.00 <br /> E TEMPORARY CLOSURE FEE = $150.00 each,TANK <br /> p PLAN CHECK (Install. Plan Review 8 Construction Inspections) TANK I.D. #(s) <br /> L <br /> re minimum q $424.00 minimum % <br /> N PLAN CHECK FEE - 553.00 per hour (B houmi Am per Facility) _ <br /> TANK I.D. #(s) - <br /> R REPAIR FEE (workplan review 8 construction irspectiolu) # TANK(s) _, % $159.00 S <br /> E <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimm/TAN <br /> A S <br /> I <br /> R PIPING REPAIR FEE 253.00 per hour (3 hour mini" per facility - $159.00) <br /> H TRANSFER FEE • 520.00 UNAUTHORIZED RELEASE EVALUATION 553.00/hr <br /> S <br /> I <br /> = 553.00/hr S <br /> g <br /> C CONSULTATION FEE = 553.00/hr SAMPLING INSPECTION FEE TOTAL DUE f 7-34 <br /> 1110-t K- <br /> ___._Ni��M�4?yr�T��`� •- _:_�_�C5. i <br /> sITEEP C U`IE iYi 6I3n'P'�615 A�i(SU11T IIC' CwEC�#ICAS- E'CCVEIS'liW '�"LLISATE`kECETVE <br /> Page 11 <br /> EH 23 032 (Revised 4/8/91 <br /> ��/,/c,'�n�`,'. e- <br /> D <br />