Laserfiche WebLink
SAN JOAQUIN Com'( PUBLIC HEATH SERVICES - ENVIRONMENTALH H DIVSICN <br /> 1UIRIP"`.•''�ND STORAGE TANK PROGRAM - FEE WORKSHEE� <br /> SI FACILITY SITE NAME I FACILITY CONTACT NAME <br /> IELMER F. KLUDT & SONS, INC. STEVE KLUDT <br /> E FACILITY ADORESS SITE PHCNE x with AREA CODE <br /> 1126 E . PINE 209-466-8969 <br /> b <br /> A CITY LODI SNE 77tffi # of TANKS <br /> P at SITE <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L STOCKTON SERVICE STATION EQ. CO. I C. MIKE FLORES <br /> C MAILING ADDRESS APPLICANT PHONE x WITH AREA CODE <br /> A P. O. BOX 508 <br /> N 209-464-8333 <br /> TI CITY STATE ZIP CODE TYPE of APPLICATION <br /> STOCKTON CA 95201 (Closure, Installation, etc.) <br /> TOTAL <br /> 1 1 1 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) � $100.00 1986 1987 1988 11989 1990 <br /> A <br /> C XXXXXX XX I f <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) <br /> I XXX% %XXX $ <br /> V TANK FEE = 550.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> x Tanks = 1986 1987 1988 11989 1990 11991 11992 1993 11994 11995 1996 <br /> F (multiplyxx ly fee far <br /> A each year applicable) XXXX an I I I I I f <br /> C' <br /> I TANK PENALTY FEES ASSESSED I XXXX XXX% I f <br /> Lr- <br /> 11 STATE SURCHARGE = S56.00 each TANK (Due every 5 years) See California H 3 S Code, Section 25287 <br /> T' <br /> Y x Tanks x 556.00 1988 through 1990 1991 through 1996 <br /> t (Enter amount and year) <br /> � f <br /> Cl PERMANENT CLOSURE (Removal or Authorized Closure-in-P(ace) TANK I.D. x(s) <br /> L <br /> 0CLOSURE FEE = S78.00/hour (3 hours minimm/TANK) x TANK(s) X $234.00 = S <br /> S — <br /> U- TEMPORARY CLOSURE (Plan Review i Inspections) TANK E.D. x(s) <br /> R <br /> EI TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimuP/FACILITY) 3234.00 minimum $ <br /> PI INSTALLATION PLAN CHECK (Plan Review 3 Construction Inspections) TANK I.D. N(s) <br /> L <br /> A <br /> N PLAN CHECK FEE _ $78.00/hour (8 hours minimum/FACILITY) = S624.00 minimm S <br /> R REPAIR FEE (workplan Review 3 Construction Inspections) TANK [.D. x(s) <br /> E, <br /> P TANK LINING REPAIR FEE = S78.00/hour (3 hours minimum/TANK) N TANK(s) X 5234.00 = S <br /> A <br /> I <br /> R TANK RETROFIT REPAIR FEE = 378.JO/hour (3 hours min./FACILITY) = s234.00 minimm S <br /> J <br /> PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACIL[T7) _ $234.00_ mininAA4 $234.00 <br /> Z� <br /> Ml TRANSFER FEE • 520.00 I i UNAUTHORIZED RELEASE EVALUATICN - S78.00/hr I S u <br /> S <br /> CI CONSULTATICN FEE - S78.00/hr SAMPLING INSPECTION FEE - S78.00/hr s <br /> TOTAL DUE $234.00 <br /> FOR OFFICE USE ONLY <br /> SWEEPS x COMPUTER x LOC CODE DIST CODE AMOUNT .-RRECEIVED CHECK x/CASH RECEIVED 3Y DATE RECEIVED <br /> ziS <br /> EH 23 032 (REVISED 10-28-93) 3 <br />