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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UHDERGRCUNO STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CNTACT NAME <br /> F <br /> A Naval Reserve Center, Stockron, CA <br /> C Lt. Betton <br /> I FACILITY ADDRESS SITE PHONE S with AREA CODE <br /> L 3100 Monte Diablo Avenue (209) 944-0515 r 1991 <br /> 7 CITY STATE 22P CODE X of TANKS <br /> Y Stockton CA 1 95203 at SITE 1 ENIViiNIOVT/ NTAI HEALTH <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P Riedel Environmental Services Jeff Nieland <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE S WITH AREA CODE <br /> c 4138 Lakeside Drive (415) 222-7810 <br /> A <br /> N CITY STATE ZIP CODE TYPE of APPLICATION <br /> Tj Ric'nmond CA 94806 closuaE, INSTALLATIGN, etc. CLOSURE <br /> A TOTAL <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br /> I E <br /> V <br /> E TANK FEE = S50.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F 7 Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply X bytee for <br /> C each year applicable) S <br /> L STATE SURCHARGE = S56.00 each TANK (Due every 5 years) See California H & 5 Code, Section 25287 <br /> 1 <br /> T # Tanks x S56.00 1986 through 1990 1991 through 1996 <br /> T (enter mount and year) <br /> 5 <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> C <br /> L CLOSURE FEE = $53.00 per hour (3 hours minimus per TANK) # TANK(s) I X 5159.00 = <br /> 0 5 159.00 <br /> S <br /> U TEMPCRARY CLOSURE (A one-time permit, for review/inspections) TANK I.D. X(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = 5150.00 each TANK 0 TANK(s) X S150.00 = S <br /> P PLAN CHECK (Install. Plan Review & Construction Inspections) TANK I.D. N(s) <br /> L <br /> A <br /> 4 PLAN CHECK FEE - $53.00 per hour (8 hours mininn per Facility) = S424.00 mini*Mn S <br /> R REPAIR FEE (workplan review & construction inspections) TANK I.D. 1(s) <br /> E <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimun/TANK) Y TANK(s) X $159.00 = E <br /> A -- <br /> I <br /> R PIPING REPAIR FEE = S53.00 per hour (3 hour minimus per facility = S159.00) S <br /> M CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> S <br /> C FEE = 553.00/hr FEE = 553.00/hr FEE = S 53.00/hr <br /> TOTAL DUE s 159.00 <br /> OFFICE USE ONLY <br /> 1111"'511""IrCmt� ',�1'C�`C'�w``'�i E'C�/T`.(�Sils "a` +• ma`s' jr �.=:.`s <br /> a <br /> S <br /> .S 1K feti lY.f SRM it i[Mi�MJP4 Ml of\BKAi?Y4IbNY lAS N1M[i Yii zl M1SM»YY S4 StM�I�if of�W fYYfillot Sl>i Ml�Sf i1f ilS <br />