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SAN JOAQUIN COON JBL1C HEALTH SERVICES - ENVIRONMENTAL HEALT" IVSIONI <br /> UNDE JND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> S �•FACILITY SITE NAME FACILITY CDNTACT NAME <br /> I PETER F. PERSIL <br /> T <br /> E FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> CITY STATE ZIP CODE # of TANKS <br /> A STOC KTON CA 952(2 at SITE TWO <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> I PROPERTIES PETER F. PERSIC <br /> AC PPif0I BOX `t��ADDRES APp�I1Z3T ��N�{E�2Wu <br /> 4/ AREA CODE <br /> 0.T TY S,,��AATE Z f,6n TYPE of APPLICATION <br /> 1RTH HOLLYWOOD t,A �1DU� (Closure, Installation, etc.) <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = S100.00 <br /> A S <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XXXX S <br /> I <br /> V TANK FEE = $50.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> 4 # Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F (multiply # by fee for <br /> A each year applicable) S <br /> r <br /> I TANK PENALTY FEES ASSESSED XXXX XXXX S <br /> L <br /> I STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H & S Code, Section 25287 <br /> T - <br /> Y » Tanks x $56.00 1986 through 1990 1991 through 1996 <br /> (Enter amount and year) - <br /> S <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> L r�CQ 1712- <br /> 0 CLOSURE FEE = $78.00/hour (3 hours minimum/TANK) # TANK(s)� X $234.00 = 468'oo <br /> S <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) <br /> Ra <br /> E FTEMPORARY CLOSURE FEE = $78.00/hour (3 hours minimum/FACILITY) = S234.00 minimus 3 <br /> P INSTALLATION PLAN CHECK (PLan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = $78.00/hour (8 hours miniaLWFACILITY) = S624.00 minimum S <br /> R REPAIR FEE (Workplan Review & Construction Inspections) TANK I.D. #(S) <br /> E <br /> P TANK LINING REPAIR FEE = $78.00/hour (3 hours minima/TANK) # TANK(s) X $234.00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE = $78.00/hour (3 hours min./FACILITY) = $234.00 minimum S <br /> R <br /> PIPING REPAIR FEE = S78.00/hour (3 hours minimum/FACILITY) = S234.00 minimum S <br /> M TRANSFER FEE _ $20.00 UNAUTHORIZED RELEASE EVALUATION = 578.00/hr S <br /> I _ <br /> 5 <br /> C CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE = $78.00/hr S <br /> TOTAL DUE S 468-00 <br /> FOR OFFICE USE ONLY <br /> xiro xas nweo xw.H.m.ti..»wa»w aw»ww»oo www»..�.a.aa»»«»M..►s....r�ey.w..r.«.w..�..r..»�..�.w.�»x�aa»»�«»wrae►raa.►s.w»re►�.�we►�..�..ee.eo r.r»aa ee.roa.z..».r.a..�..»«»»»�sr <br /> $ ,. <br /> EH 23 032 (REVISED 3-1-93) Paae 11 <br />