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'12-24-1998 8.56AP1 FR0,1 3f
<br /> SAN JOACUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTa. jlVSI09 c� nn
<br /> UND5RGROUNO STORAGI TANK PROGRAM - PEE WORKSHEET 2 098
<br /> S FACILITY SITE NAME FACILITY CONTACT NAME
<br /> I R�CQ SC I Lk"lc, A S
<br /> Et FACILITY ADDRESS SITE PHONE # with AREA CODE
<br /> V)6-16- (ao `�b 66-31
<br /> A CITY STACITE Z�6aOS atCODE ;t oTANKS
<br /> SETE3
<br /> P 5 ���
<br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME
<br /> LI TCQ� CV C\CU
<br /> I
<br /> C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE
<br /> x
<br /> T CITY i TATEI ZIP CODE TYPE of APPLICATION i
<br /> )p (Closure, Installation, etc.) U G
<br /> TOTAL
<br /> 1986 1987 1988 1989 1990
<br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00
<br /> A XXXX X%XX XXXX XXXX XXXX S XXXXXXXX i
<br /> C
<br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) I XXXX XXXX XXXX XXXX XXXX S XXXXXXXX
<br /> I
<br /> yl-
<br /> TANK FEE 550.00/TANK (Prior to January 1,1991) , S170/TANK (After January 1, 1991)
<br /> £) # Tanks = 1988 ( 1989 1 1990 1991 1992 1993 1994 11995 1996 1997 1998
<br /> F+ (multiply by fee for
<br /> A
<br /> each year applicable) XXXX XXXX XXXX { XXXX iXXXX $
<br /> I TANK PENALTY FEeS ASS'cSSED f XXXX XXXX XXXX XXXX XXXX
<br /> i I f �
<br /> L'
<br /> I) STATE 'SURCHARGE FOR NEW FACILITIES ONLY=SIM0 $
<br /> T E
<br /> 199$
<br /> Y # Tanks x $8.00 1988 through 1993 (556) 1993 through 1997 (S56)
<br /> SURCHARGE FOR 1998 XXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXX%XXXXXXX S
<br /> Ci PERMANENT CLOSURE (Removai or Authorized Closure-'n-Piace) TANK L.D. m(s) -
<br /> L
<br /> 01 CLOSURE FEE = 37$.00/hour (3 hours minimum/TANK) i # TANK(s) X $234.00 $
<br /> S ;
<br /> UI TEMPORARY CLOSURE (Plan Review & Inspections) I TANK I.D. #(s)
<br /> R.
<br /> E, TEMPORARY CLOSURE FEE ■ 978.00/hour (3 hours minimum/FACILITY) ! $234.00 minimum :s
<br /> PINSTALLATION PLAN CHECK (Plan Review & Construction Inspec:ions)� TANK I.D. #(s)
<br /> L
<br /> A
<br /> N� PLAN CNECK FEE = $78.00/hour (8 hours minimum/FACILITY) a 5624.00 minimum S
<br /> R REPAIR FEE (Workplan Review g Construction Inspections) TANK I.D. #(s) -- i
<br /> ES
<br /> FE
<br /> P TANK LINING REPAIR £ a 578.00/hour (3 hours minimum/TANK) ! # TANKS) _ X $234.00 =
<br /> A
<br /> ( TANK RETROFIT REPAIR FEE - S78.00/hour (3 hours milt./FACILITY) = $234.00 minimum S
<br /> R I
<br /> PIPING REPAIR FEE = s78.00/hour (3 hours minimum/FACILITY) = SZ34.00 minimum $
<br /> i
<br /> M TRANSFER F'cE 920.00 UNAUTHORIZED R5LEASE EVALUATION = S78-00/hr $
<br /> I
<br /> S k g
<br /> C CONSULTATION FEE = $78.00/hr SAMPLING INSPECTION FEE = $78.00/hr `
<br /> TOTAL DUE S
<br /> FOR OFFICE USE ONLY „ --_ ...,:,:;.;.,.t,-, t
<br /> »_.........., _... ......---.......,,.• ..................... •...:..-::__......:-::::::::::..._........ .-_—._......._........._................
<br /> .._:.:............ ................._...........: ,:,:�.—•.:....:.:...... =�,::::,,..._.._...... .._... ,iE.r:::::i::-_:�--1 r=,iiui:Iolalttltlr-:,;..__....---_::,e=r.,nnE�,t�,♦fil�i-:.—___-:::::_�::::-,,,1„it-1,::._::::::� ::r .av,ri
<br /> nc......._....�� E.1.............._..:::�::ris,rnFlfilEklk.l._i�_.__,..nsvr.n„ddrGYLIkL,—.._...�___._-e-1.i.u,aun,LLi.iSN., r.r• eum
<br /> SWEEPS $ i COMPUTER N I LOC CODE DIST CODE I AMOUNT RECEIVED I CPECY SICASH I RECEIVED BY E DATE RECEIVED
<br /> ..,-----......._ .....__. �.-------,,,rn�r;k:In�nGhlsr.E�„rr.r::�-:: ��:::-f:::::-si:iiioar!!:_:;:_:::::ist;;ta;-itiaal�t�:•;iGi,
<br /> ......•„!X711...._._....._.._.........................:.,i iilEtl.;..;........_rinx E „ _.__..__.• _uG,�uwfdilNRlil•!�P!'.-'S�-.---_.—......_»._....,dunU�':.::::=-
<br /> �uill:r!!!!"'•':_yin_::::e:::::::cii=: ...liill._.:-_:"":ii&N%f-+..'r..._....�::_.._:�._....i...7itiKkEEL.tlynaLs•c�:�;:r3i_•__-�-..........ini,.i1S�!'-:-�_�:_:r1:_a.
<br /> FN 21 (137 IRFVTSFtI
<br />
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