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02/2412005 13:47 2094683433 FIFTH FLOOR PAGE 01 <br /> SAN JOAQUIN COUNTY u�` J r,u `�F-�) <br /> ENVIRONMENTAL RSALTH DEPltRTAdENT <br /> 304 East weber Avg,31°Fkw.&ocku7n,cA 95202-2708 r=E f 3 2 8 ?009 <br /> Tefepho3at»•(203)458-3420 Fax(3"'jkw)r(209)468-3633 Web:www.pjgov-°T8k?� <br /> FACILITY NAME FACiLi C0NTACT NAmra <br /> FACILITY ADORM SITE Kmif A VVITW <br /> 3 ,.=.7 / 7 75- <br /> 012X STATE ZIP CODE OF TANKS AT 91TE <br /> CA 3 <br /> APPUCA BILLING E APPLIC-1A-NTOWACTMAME ' <br /> APPLICANT MAILING ADOMs AAPLK3ANT#+NON9# ASA CODE <br /> CITY STATE ZIF COO$ CIRCLE tlVQRK TO BE DONE OONTRACTCNi ICC#P <br /> i C''�t 7l e6 <br /> ACTIVE FACILITY <br /> $5034 FEE INCLUDES FACILITY FEE+1 TANK 2000 2001 2002 2003 2004 2005 <br /> 4 $126 PER TANK AFTER FIRST TANK <br /> TANK PENALTYASS :SED $ <br /> TANK SURCHARGE=$15/TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM 0$24.001 FACILITY � <br /> PERMANENT CLOSURE <br /> Remov&t 4t Psrm>xmtl Closure in Plstx <br /> TA ID Ir S CLOSURE'FEE_$279 f TANK B TANKS 7($27$ <br /> TEMPORARY OZOSUR <br /> (Pion Roview and Ins coons <br /> TANK ID#(s)., TTEMKIRARY CLOSURE FEE_$2791 FACILITY � <br /> INSTALLATION PLAN OHM <br /> Plan Cheek and Gods ian i <br /> TANK ID S(s). PLAN CHECK FEE=$744 i FACIUTY <br /> REPAIR PLAN CHECK <br /> TANK ID.*(s): <br /> TANK RETROFIT REPAIR FEE ■$2791 FACILITY (use for monitarin *=Vmnt 14 buckets tank sumps,mica) $s� <br /> PIPING REPAIR FEE =$2791 FACILITY use for .under-d nsa cardakunant,act. $ <br /> MWELLANEGUS <br /> TRANSFER FEE e $20 $ <br /> CONSULTATION FEE 931 HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE s 931 HOUR $ <br /> SAMPLING INSPECTION FEE = S 5:i/HOUR $ <br /> M.L pm AR6 ON THE ss3 HOURLY RATS. iNRT I°MCt6 FEES PAW M.L BER TO APPLICANT. <br /> OFFICE USE ONLY <br /> 9I y1 # FACn.nYIV I AMMIT Roca= 014EVKN Eo <br /> SR <br /> EH 23 00 PIMRSW 0Z=fQ53 <br />