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FROM :TLM PETRO LABOR FORCE FAX NO. :5629238138 al. 28 2004 01:03PM P2i7 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> FACILITY NAME FACILITY CONTACT NAME <br /> Arco 6313 JeaN�c+le.. <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 1100 15 . Main (2-09) $25', d`F <br /> CITY STATE I ZIP CODEF TANKS AT SITE <br /> maul k Ca CA 85'33 *O <br /> -7- 3 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> TLM Pet'w LA�or Force 4ic- A06,1 -Tow► <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> gibs 8A Si v► St 3f0 2S(�IS3 <br /> CITY I STATE I ZIP CODE CIRCLE WORK TO BE DONE: <br /> �bwin CA Closure Installation Repair etrofit <br /> ACTIVE FACILITV <br /> 1999 2000 2001 2002 2003 2004 <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK (Eno)x(Wanks) <br /> $125 PER TANK AFTER FIRST TANK ---" $ <br /> TANK PENALTY ASSESSED <br /> TANK SURCHARGE-$16/TANK <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$24.001 FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID#(s): CLOSURE FEE=$2791 TANK #TANKS X$279= <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID#(s): TEMPORARY CLOSURE FEE=$279/FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) - <br /> $ <br /> TANK ID#(s): PLAN CHECK FEE=$744!FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <br /> TANK RETROFIT REPAIR FEE =$279/FACILITY (use for monitoring equipment,spill buckets,tank sumps.misc.)$ <br /> PIPING REPAIR FEE _$279/FACILITY use for piping,under-dispenser containment,ect. <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $20 <br /> CONSULTATION FEE = $93/HOUR <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $93/HOUR <br /> SAMPLING INSPECTION FEE _ $931 HOUR <br /> ALL FEES ARE BASED ON THE$93 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REOUE8T# FACILITY ID I AMOUNT RECEIVED CHECK IV RECEIVED BY DATE RECEIVED <br /> SR <br /> EH 23 032(REVISED 01112104) <br />