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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br />FACILITY SITE NAME FACILITY CONTACT NAME <br />F <br />A T o 1 <br />C <br />I FACILITY ADDRESS <br />L 975 S. Fairmont A <br />T CITY <br />Y Lodi <br />A APPLICANT/BILLING NAME <br />P <br />P <br />t NAILING ESS <br />C <br />T CITY <br />SITE PHONE # with AREA CODE <br />ue (209) 334-3411 <br />STATE ZIP CODE at BITENKS ( 1 ) Orie <br />CA 95240 <br />APPLICANT CONTACT NAME <br />4A8P T PH WITH AREA SOOEST TE PE of APPLICATION <br />j7 . CLOSURE, INSTALLATION, etc. <br />A <br />9 1987 '1988 1989 1940 <br />C <br />FEE (Prior to'January 1, 1991) = S100.00 <br />T ANNUAL FACILITY <br />i <br />V <br />E TANK FEE = 550.00/'fANK (prior to Jasxary 1,19914 <br />$170/TANK (after January 1, 1991) <br />F # Tanks = <br />1986 1987 1988 1989 <br />1990 1991 1992 1993 1994 1995 1996 <br />A (multiplyfee for <br />C each year app <br />I <br />SURCHARGE = $56.00 each TANK (Due every 5 years) <br />California HSS Cade, Section 2528 <br />L STATE <br />1 th 1 <br />1991 through 1996 <br />T # Tanks x 856,00 <br />Y (enter asaoexat and year) <br />PERMANENT CLOSURE (Removal or Authorised Closure-in-Ptace) TANK I.D. #(s) / <br />L CLOSURE FEE : r hour C3 hours minimum per TANK) # TANKts) X _ <br />0 <br />UT Y CLOSURE (A one-time permit, for review/inspections) T I.D. #Cs) <br /># TANKts) X $150.00 <br />E TOWORARY CLOSURE FEE = $150.00 each TANK <br />= <br />P PLAN CHECK (Install. Plan Review i Construction Inspections) T I -D- #(s) <br />L <br />A= $424.00 minimae <br />N PLAN CHECK FEE - 553.00 per hour C8 hears minim= per Facility) <br />R REPAIR FEE (workptan review L construction inspections) T I.D. #Cs) <br />P TANK REPAIR FEE = 553.00 per hour (3 hours minim WTANK) <br /># TANK(s) <br />X 5159.00 = <br />A <br />R PIPING REPA%R FEE = S53.00 per hoar (3 hour minimum per facility = 5159.00) <br />M TRANSFER FEE <br />= S20.00 I UNAUYHORIZED RELEASE EVALUATION = 553.00/hr <br />I <br />C CONSULTATION FEE = s53.00/hr SAMPLING INSPECTION FEE = 553.00/hr <br />TOTAL DUE <br />S <br />EH 23 032 (Revised 4/8/91) Page 11 <br />