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-7 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION <br /> _--UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> S FACILITY SITE NAME FACILITY CONTACT NAME <br /> I Lawrence Livermore National Laboratory C.Susi Jackson <br /> (LLNL) , <br /> T FACILITY ADDRESS SITE PHONE#with AREA CODE <br /> E Corral Hollow Road (510)423-4881 <br /> & CITY STATE ZIP CODE #OF TANKS at SITE <br /> A Tracv CA 95376 1 for Building 871 <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P LLNL C.Susi Jackson <br /> L MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> 1 7000 East Ave.,P.O.Box 808 <br /> 1 (510)423-6577 <br /> C CITY STATE ZIPCODETYPE OF APPLICATION(Closure,Installation,etc.) <br /> A <br /> N Livermore CA 94550 <br /> T <br /> ANNUAL FACILITY (Prior to1986 1987--0-8-8 1989 1990 <br /> C January 1,1991) $100.00 <br /> T $ <br /> V FACILITY'PENALTY FEES ASSESSED xxxx XXXX <br /> E (if aulicable) <br /> TANK FEE.S50-00/TANK(Prior to January 1,1991) $170/TANK <br /> — (After Jan 1,1991) <br /> F #Tanks 1987 1488 1086 1"9 11990 1991 1992 1993 1094 _105 1946 <br /> A (multiply #by fee <br /> for <br /> C each year S <br /> applicable <br /> L TANK PENALTYXXX <br /> I FEES ASSESSED <br /> T <br /> Y STATE SURCHARGE each$56=chTANK(Dueevery1years)See California H&S Code,Section 25287 <br /> #Tanks x$56.00(enter amount and 1086 through 1990-- 1991 through 19% <br /> year) <br /> C PERMANENT CLOSURE(Removal or Authorized Closure- TANK <br /> L in-Place) <br /> 0 CLOSURE FEE-S78.00/hour(3 hoursTANK I.D. Cs) x$234.00—__S___ ------ <br /> S minimum/TANK) = I <br /> U TEMPORARY CLOSURE(Plan Review & Inspections) IT I.D. <br /> R #(s)-------------------------------- <br /> $78.00/hour <br /> (s) ---- -- -------------- <br /> ji; ----------- <br /> E TEMPORARY CLOSURE FEE_$78.00/hour x$234.00= — <br /> Q hours minimum/TANK) T <br /> P_ INSTALLATION PLAN CHECK(Plan-Review& MR I.D. <br /> L Construction Inspections) <br /> A PLAN CHECK FEE-$7-8-- <br /> N .06/hour(8 hours minimum/ cility)-$624.00 minimum _17 <br /> U/1 -14 <br /> REPAIR FEE(Workplan Review&Construction TANK I.D. <br /> Inspections) #(s) <br /> P TANK LINING REPAIR FEE z;V_8.W/hour(3 hours TANK I.D. N(s) x <br /> A minimum/TANK) $234.00= <br /> I TANKRETROFITREPAIR FEE=$78/hour(3 hours minimum/FACILITY)=S234 minimum S <br /> R <br /> PIPING REPAIR FEE-_ S78.00/hour(3 hour minimum/FACILITY)=S234.00 minimum $ <br /> 0 <br />