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SAN JOAQUIN COl"'TY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HE 4 DIVSION <br /> UA (RtX)ND STORAGE TANK PROGRAM - FEE WDRKSHEE)yI <br /> 5 FACILITY SITE NAME FACILITY CONTACT NAME <br /> I Refllv's Car wash Kevin Reilly <br /> -F. FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> 100 E. Lodi Ave. (209)334-6144 <br /> & <br /> CITY STATE ZIP CODE # of TANKS <br /> A Lodi, CA 95240 at Stye 3 <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L Reilly'* Car Vash _. Kevin Reilly <br /> C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> A 100 E. Lodi Ave. (209)334-6144 <br /> N -- -- <br /> T CITY LodiST C ZIP9440 TYPE of APPLICATION R.eTmval <br /> (Closure, Installation, et6.) <br /> TOTAL <br /> 1986 1987 11988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 <br /> A %%%K XX%K %XXX XXXX X%XX $ XXXXXNXX <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) %XXX %X%X XXXX %XXX XXXX E XXXXXXXX <br /> I <br /> V TANK fee = E50.00/TANK (Prior to January 1,1991) 3170/TANK (After January 1, 1991) <br /> E <br /> 0 tanks = 1995 1989 1990 1991 1992 1993 1994 1995 7996 1997 1098 <br /> F (multiply #by fee for <br /> A each year applicable) XXXX XXX% XXXX I XX%X %XXX 9 <br /> C <br /> I TANK PENALTY FEES ASSESSED %XXX XXXX XXX% XXX% XXX% $ <br /> L -- <br /> I STATE SURCHARGE FOR NEW FACILITIES ONLY=518.50 $18.50 <br /> T <br /> Y # Tanks_ x98.00 1988 through 56) 1993 th <br /> -1993 (3rough 1997 ($56) 1998 24,00 <br /> SURCHARGE FOR 1998 XX%%%%XXXX%XXXX%%%XXXXXXXX% XX%%XXXXXXXX%XX%%XXXXXX $ <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. #(s) <br /> L -_- <br /> 0 CLOSURE FEE . $78.00/hour (3 hours minimum/TANK) # TANK(s) 3 X 9234.00 e $702.on <br /> S <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(3) <br /> IT _--_ -, <br /> E TEMPORARY CLOSURE FEE = 978.00/hour (3 hours minimum/FACILITY) $234.00 minimum $ <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK 1-0. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = 378.00/hour (8 hours minimum/fACILITY) = 5624.00 mini" S <br /> R REPAIR FEE (Workplan Review & Construction Inspections) TANK I.D. #(s) <br /> P TANK LINING REPAIR FEE = 378.00/hour (3 hours minimum/TANK) # TANK(s) X $234.00 S <br /> A-- - <br /> ---- <br /> I TANK RETROFIT REPAIR FEE _ $78.00/hour (3 hours min./FACILITY) z 3234.00 minimum % <br /> R <br /> PIPING REPAIR Fee ' $78.00/hour (3 hours minimum/FACILITY) m $234.00 minimum % <br /> M TRANSFER FEE = 920.00 UNAUTHORIZED RELEASE EVALUATION a 578.00/hr 3 <br /> I --- <br /> S -- -- <br /> C CONSULTATION FEE > $78.00/hr SAMPLING INSPECTION FEE � $78.00/hr $ <br /> TOTAL DUE 3744.50 <br /> fOR OFFICE USE ONLY <br /> -?�StF alma!Ilmmmeii: iiir!:v'�.-.ii_r2!=ii'=:e::n_.:,.e.:::cer.^..:,..•y:rr••irn rr I err minnemr:r numnr.:�nemen::c::::v-mr..:e::-ec::c::cs:::::::_-�:e- __.._..._...._. ma:mannunn <br /> _.......__.__..........a:...dr:._r.rr..._IIYI?Lli.lttlllll I l{. .,I .........9........_...r............r..........._...._....___. .-._....__._... ..i .........-.. .....__....... <br /> :::..........:::.::ar r. :::,rr.rrrrrrraulrnn.r�u�nl!116.dl.nlmlu.1.nl..pmOm.1.1..__...:......................._ ......._...........,.... .�.._�_......-rr rlriflNl_!.,!e!uJnrrr�rrrrr::mm::€i= <br /> 'LITE- <br /> :::.rr rrrm.rrrr.r rr rrr r: <br /> $WEEPS 4 COMUTER # LOC COD! DIST CODE I AMOl1NT RECEIVED I CHECK #/GaSH RECEIVED BY I � DATE 0.EC£1VED <br /> 11Y•:rnn'� ... 4.^' � rrurr•nlmn.!mNnlnmmmlmmn'I n 1, S fit a£; +'-:.i 4 nl a x�r Fh lnl i �. ru 'TM1 n F-�9'iirl(�-rr/rrM <br /> 11 e <br />