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v <br /> SAN JOAQUIIN CMUT PUBLIC NEALTN SERVICES - ENVIROMMENTAL WLTN DIVSION <br /> STORAGE TANK PROGRAN - FEE WORIMW <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> I Arco Arthur Wyatt <br /> T <br /> E FACILITY ADDRESS SITE PHONE eft with AREA CODE <br /> & <br /> 4511 Pacific Avenue <br /> Ctiv STATE ZIP CODE 9 of TANKS <br /> A Stockton CA 95207 at SITE <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L Arthur W att Brian Goins <br /> .I <br /> C MAILING ADDRESS APPLICANT PHONE N WITH AREA CODE <br /> A 6290 Chesapeake Circle 209 951-1209 <br /> N <br /> T CITY STATE ZIP CODE YYPE of APPLICATION Installation <br /> Stockton C) 95219 (Closure, Instattation, etc.) <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) _ $100.00 <br /> A f <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Appticabte) XXXX i <br /> I <br /> E TANK FEE = $50.00/TANK (Prior to January 1,1991) 1170/TANK (After January 1, 1991) J <br /> 0 Tanks = Ali 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F (muttipty 0 by fee for <br /> A each year applicable) S <br /> C <br /> I TANK PENALTY FEES ASSESSED XXXX XXXX S <br /> L <br /> T STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California N & S Code, Section 25287 J <br /> Y it Tanks_t x $56.00 1984 through 1990 1991 through 1996 N <br /> (Enter amount and year) �77 77 <br /> �V2a <br /> $ <br /> C PERMANENT CLOSURE (Removal or Authorized Ctosure-in-Ptace) TANK B.D. #(a) <br /> L <br /> 0 CLOSURE FEE _ $78.00/hoer (3 hours minimum/TANK) 0 TANK(s) X 5234.00 ■ $ <br /> S <br /> U TEMPORARY CLOSURE (Ptah Review & Inspections) TANK I.D. Etta) <br /> R <br /> E TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) N TANK(s) X 5234.00 ■ S <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. S(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = S78.00/hour (8 hours minimum/FACILITY) ■ 5624.00 minimum <br /> R REPAIR FEE (Norkptan Review & Construction Inspections) TANK I.D. e1(s) <br /> E <br /> P TANK LINING REPAIR FEE 3 578.00/hour (3 hours minimum/TANK) 0 TANK(s) X 5234.00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE = $78.00/hour (3 hours min./FACILITY) = 5234.00 minimw S <br /> R <br /> PIPING REPAIR FEE ■ $78.00/hour (3 hours minimum/FACILITY) ■ $234.00 minimum $ <br /> N TRANSFER FEE = $20.00 UNAUTHORIZED RELEASE EVALUATION = 578.00/hr S <br /> I <br /> S <br /> C CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE = S78.00/hr S <br /> TOTAL DUE <br /> • <br /> FOR OFFICE USE ONLY <br /> .9ti}t?!?ittii•:!t!itittttf".lttl3!tRtim4tttltmii! SMm <br /> :&a:'LL'LeiifSiiiii8iil°filFi6iFi£:iFlitWiiaillfi?lilml ' <br /> SWEEPS N COMPUTER N LOC CODE DIST CODE AMOUNT RECEIVED CHECK N/CASH RECEIVED BY DA RECEIVED <br /> :m <br /> iiBF.ntarr.N?3.T.9!tUmIUNM?fifk .. !!"_!mt!^E ._ ... <br /> M°.dMAdak <br /> UL•7ifiUm:W116iiGllUmmiifiiililfimLliOFm _ <br /> EN 23 032 (REVISED 11-1-92) Page 09 <br />