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5-26-1996 1 :48PM FROM P. d <br /> SAN JOIOUIN COUNTT PUBLIC HEALTH SERVICES - ENVI AL HEALTH DIVSION <br /> UNDERGROUND STORAGE TANK PROGRAP - FEE WORKSNEET <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> T - 2 1. <br /> E FACILITY ADDRESS SITE PHONE # with AREA CODE <br /> 75 <br /> CITY STATE ZIP LODE N of TANKS <br /> A <br /> P C—EQ at SITE <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> 1 SDE <br /> z'r W int l—j <br /> C MAILING ADDRESS APPLICA)IT PHONE N WITH AREA CODE <br /> N <br /> T CITY STATE ZIP CODE TYPE of APPLICATION <br /> `j(�1 SVS X51)a (Closure, Installation, etc.m6 —� <br /> TOTAL <br /> 14$6 ;987 148E 1954 1940 <br /> ANNUAL FACILITY FEE (Prior to dowry 1, 1991) = 3100.00 <br /> A )O= XXXX ! xxxx XXXR )0= S xxxxxxxx <br /> C 1 <br /> T FACILITY PENALTY FEES ASSESSED Cif Applicable) XXXX X= XIDiX 30CXX XXXX 6 XXXXX)UO( <br /> i <br /> V TANK FEE 2 S50.00/TANK CPrior to January 1,1941) 5170/TANK (After January 1, 1991) <br /> E <br /> x Tanks a 1997 19M � 1489 1940 1941 ! 1942 1943 1944 � 1995 19% t997 <br /> F (multiply 2 by fee for <br /> A each year amticable) XXXXXXXX XXXX XX)IX xxxx S <br /> C <br /> I TANK PENALTY FEES ASSESSED xxxx xxXX XXXX )XXX xxxx ( S <br /> L <br /> I STATE SURCHARGE FOR NEW FACILITIES ONLY = 418.50 <br /> T �6 <br /> Y A Tanks x 58.00 19M through 1990 (S%) 1991 through 1996 CS56) 1947 <br /> SURCHARGE FOR 1447 =MWOODOODOODDOWWWOOM <br /> 6 <br /> C PERWEqT CLOSURE (Removat or Authorized Closure-in-Ptace) TANK I.D. 4(s) <br /> L <br /> 0 CLOSURE FEE = 578.00/hour 0 hours minimum/TANK) uT TANK(s) X 5234.00 = 6 <br /> S <br /> U TEMPORARY CLOSURE (Plan Review 3 Inspections) TANK I.O. it(S) <br /> R <br /> E TEMPORARY CLOSURE FEE = S78_00/hoar (3 hours minimWFACILITY) 5234.00 minimum S <br /> P INSTALLATION PLAN CHECK (Plan Review 8 Construction Inspections) TAMC I.O. x(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = S78.00/hour (E hours minimum/FACILITY) ■ 4624.00 minimum 6 <br /> R REPAIR FEE (Workpian Review It Construction Inspections) TANK I.O. NO) <br /> E <br /> P TANK LINING REPAIR FEE 2 578.00/hour (3 hours mini TANK) N TANK(s) X 6234.00 : S <br /> A <br /> I TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours gain./FACILITY) = 6234.00 minima $ <br /> R <br /> PIPING REPAIR FEE ■ S78.00/hour C3 hours minimua/FACILITY) 3234.00 minimum 3 <br /> N TRANSFER FEE a 620.00UNAUTHORIZED RELEASE EVALUATION = S70.00/hr '�`�� " Sj:2, <br /> I <br /> S ' <br /> C CONSULTATION FEE = 378.00/hr SAMPLING INSPECTION FEE a S75.00/hr S <br /> TOTAL DUE ! ` <br /> FOR OFFICE USE ONLY <br /> ,..,.�..�=`-�'+ca. -Joao_..._.—�—•.•.=_.- �,,,,;; __.._ '�='�'.: ;_= ---��:: .�:^:�� <br /> SUEEPS >T COMPUTER 0 LOC COOS DIST CODE AMOUNT RECEIVED { CNECX N/CASN RECEIVED Sy ! DATE RECEIVED <br /> a <br />