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SAN JOAQUIN TY PUBLIC HEALTH SERVICES- ENVIRONMENTAL DIVSION <br /> ERGROUIID STORAGE TANK - FEE I �1 <br /> s <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> 1 Waterloo Feed & Fuel <br /> T <br /> E FACILITY ADDRESS (1,A)PT96# y,,tP6J ' CWE <br /> 3032 E. Waterloo Road 4466 77ti11 <br /> & <br /> CITY STATE ZIP CODE # of TANKS <br /> A Stockton Ca 95205 at SITE four (4) <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L Waterloo Feed & Fue . Gur al Sidhu <br /> I <br /> C MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> A same as above same as above <br /> N <br /> T CITY STATE ZIP CODE TYPE of APPLICATION <br /> (Closure, Installation, etc.) <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br /> A XXXX XXXX XXX( XXXX XXXX S XXXXXXXX <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) XXXX XXXX XXXX XXXX XXXX s XXXXXXXX <br /> I <br /> V TANK FEE = 550.00/TANK (Prior to January 1, 991) 3170/TANK (After January 1, 1991) <br /> E <br /> # Tanks = 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 <br /> F (multiply # by fee for <br /> A each year applicable) XXXX XXXX XXXX XXXX XXXX S <br /> C <br /> I TANK PENALTY FEES ASSESSED XXXX XXXX XXXX XXXX XXXX S <br /> L <br /> I STATE SURCHARGE FOR NEW FACILITIES ONLY = S18.50 �3 <br /> T <br /> Y # Tanks x $8.00 1988 through 1990 ($56) 1991 through 1996 ($56) 1997 <br /> SURCHARGE FOR 1997 XXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXX S <br /> C PERMANENT CLOSURE (Removal 'or Authorized Closure-in-Place) TANK I.D. #(s) <br /> L <br /> 0 CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) # TANK(s)_.A_ X 5234.00 = S 936.00 <br /> S <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I.D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = 378.00/hour (3 hours minimum/FACILITY) $234.00 minimum S <br /> P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = $78.00/hour (8 hours minimun/FACILITY) = $624.00 minimum I-S <br /> R REPAIR FEE (Workplan Review & Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE = S78.00/hair (3 hours minimum/TANK) # TANK(s) X 5234.00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = $:234.00 minimum $ <br /> R <br /> PIPING REPAIR FEE = $78.00/hour (3 hours minimum/FACILITY) = S234.00 minimum S <br /> M TRANSFER FEE = S20.00 UNAUTHORIZED RELEASE EVALUATION = $78.00/hr S <br /> I <br /> S <br /> C CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE = S78.00/hr I S <br /> TOTAL DUE S 936.00 <br /> FOR OFFICE USE ONLY <br /> SWEEPS _# COMPUTER # LOC CODE DIST CODE AMOUNT RECEIVED CHECK #/CASH - RECEIVED BY DATE RECEIVED <br /> m S <br /> - - 1 11 gill ...—.ter ...... .-. <br /> EH 23 032 (REVISED 5-27-97) <br />