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SAH JOAOIJIN CL' „ PUBLIC HEALTH SERVICES - EXVIR NMEXTAL rH DIVSI011 <br /> Ut 32Q.sm STORAGE TANK PROGRAM - FEE NORxsma <br /> SITE NAME <br /> J & L Market I FACILITY CONTACT NAME <br /> iADDRESS Ps owner <br /> 8115 S . E1 Dorado St . 2109-982-with <br /> 97EA CODE <br /> STATEE95231 <br /> ODE 9 of TANKS <br /> French Camp a at sITE2Tanks 3 Products <br /> T/BILIING NAME APPLICANT CONTACT NAME <br /> J & L Market James Fisk , Owner <br /> ADDRESS <br /> 8115 S • E1 Dorado St APPLICANT PHONE 0 WITH AREA CODE <br /> 209-982-0897 <br /> French Camp I STATE ZIP CODE TYPE of APPLICATION <br /> Nh a 95231 (Closure, Installation, etc.) <br /> TOTAL <br /> ►ACILITY FEE (Prior to January 1, 1991) $100.00 1986 11987 1988 1989 11990 <br /> X)= XJGYx s <br /> PENALTY FEES ASSESSED (If Applicable) I xxxx I =a <br /> f <br /> u ■ 350.00/TA14K (Prior to January 1,1991) 5170/TANK <br /> (After January 1, 1991) <br /> 31986 1987 1988 1989 11990 1991 11992 11993 1994 11995 11996 <br /> ply tf by fes for <br /> •r applicable) X)= XJOC( I I X X10 . 00 <br /> NALTY FEES ASSESSED XXXX XXXX I F $ <br /> =UR CHARGE = $56.00 each TANK (Due every 5 years) See California H b S Code, Section 25287 <br /> x $56.00 1988 through 1990 <br /> mount and year) 1991 through 1996 1 <br /> $168 . 00 <br /> NT CLOSURE (Removal or Authorized Closure-in-Place) I TANK 1.0. N(s) <br /> FEE = 578.00/hour (3 hours minim m/TANK) x TANK(s) X 5234.00 = <br /> S <br /> RY CLOSURE (Plan Review & Inspections) TANK I.D. x(s) <br /> T CLOSURE FEE = 578.001hour (3 hours minimum/FACILITY) 5234.00 minimum <br /> S <br /> yLATION PLAN CHECK (Plan Review 8 Construction Inscections)I TANK I.O. N(s)_ 1�✓L). �2 3 <br /> �,OECX FEE = 578.00/hour (8 hours minimun/FACILITY) $624.00 minimua-�kGG (7-2 6624 . 00 <br /> R FEE (Workplan Review & Construction Inspections) I TANK I.D. ?(s) <br /> PRING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) I x TANK(s) X 5234.00 i <br /> RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = 5234.00 minimum S <br /> REPAIR FEE - 578.00/hour (3 hours minimum/FACILITT) = 5234.00 miniaLm <br /> 5 <br /> *FIR FEE = 520.00 I I UNAUTHORIZED RELEASE EVALUATION = 578.00/hr I S <br /> I I I <br /> TATION FEE 278.00/hr SAMPLING INSPECTION FEE = 578.00/hr <br /> S <br /> TOTAL DM s1302 . 00 <br /> Ci usE ONLY ► <br /> Y I COMPUTER X I LOC CODE I DIST CODE I AMOUNT RECEIVED CHECK 4/CASH ( REC.'-IVEO gY I DATE RECEIVED a <br /> MEE- <br /> (REVISED 10-28-93) <br />