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SAN JOACUIN CCUNTY PUBLIC HEALTH SERVICES <br /> UNOWENVIRONMENTAL HEALTH DIVISION <br /> NO STORAGE TANK PROGRAM FEE WCRXSHEET 0 <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F <br /> A. - It:- co yu <br /> C _ <br /> I FACILITY ADDRESS SITE PHONE # with AREA C <br /> L (aoci) Lf� <br /> 49 q7 0 L <br /> I 5 � <br /> TCITY3 <br /> Sh STAr ;9 CODE of TANKS <br /> Y <br /> at SITE <br /> 141 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P <br /> L <br /> I MAILING ADORES$ APPLICANT PHONE # WtTN-iREA CODE <br /> C 0 <br /> A 2 <br /> N CITY STATE ZI CCOE TYPE of APPL1rAT4GW <br /> T CLOSURE, %1ALLATIqq_,atc. <br /> TOTAL <br /> A <br /> C 1986 1987 1988 1 1989 1 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) $100.00 — <br /> I /Orl/Ool /001/0 S 'YOO <br /> V <br /> E TANK FEE = 550.00/TANK (prior to January 1,1991) $170/TANK (after January 1, 1991) <br /> F 0 Tanks = 1986 1987 1 1988 1 1989 1 1990 1991 1 1992 1 1993 1 1994 1 1995 1 1996 <br /> A (muttipty 9 by fee for — <br /> C each year appticabte) l6b-W 156- 1116-11761 1 1 1 1 56l�o <br /> L STATE SURCHARGE - 556.00 each TANK (Due every 5 years) See Catifornia H & S Code, Section 25257 <br /> I <br /> T 0 Tanks_L_ x 556.00 1986 through 1990 1991 through 1996 <br /> Y (enter amount and year) <br /> I S&P-% ZZ971 <br /> PERMANENT CLOSURE (Removal. or Authorized Closure-in-Ptace) TANK I.D. 9(s) <br /> C <br /> L CLOSURE FEE a $53.00 per hour (3 hours minimum per TANK) I TANK(s) X $159.00 <br /> 0 <br /> S <br /> U TEMPORARY CLOSURE (A one-time permit, for review & inspections TANK I.D. #(s) <br /> IR :E <br /> E PCRARY CLOSURE FEE = 5150.00 each TANK X TANKCs) _ X 5150.00 <br /> [ <br /> P PLAN CHECK (Instalt. Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE $53.00 per hour (8 hours mini" per Facitity) = 5424.00 miniff&= S <br /> R REPAIR TANK I.D. S(s) <br /> E <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimum/TANK) X TANK(s) _ X $159.00 <br /> A <br /> I tR PIPING REPAIR REVIEW & CONSTRUCTION = 553.00 per hour (3 hour minimumper fa!Lltity = $159.00) s <br /> M CONSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION 0 <br /> 1 <br /> S <br /> C FEE $53.00/hr <br /> FEE 553.00/hr FEE S 53.00/hr <br /> = 7— <br /> T&AL D&El S <br /> OFFICE USE ONLY <br /> C.CDE ZEE k6b­ "-E.'. 0 lWil <br /> E X A— .IrT HE <br /> S <br /> --------------- ............ .......I.............................. .................................................. <br />