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SAN JOAGUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL H H DIVSION <br />�AiROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br />FACILITY CONTACT NAME <br />SITE PHONE » with AREA CODE <br />OE » of TANKS <br />at SITE <br />APPLICANT CONTACT NAME <br />Gary m4w= <br />APPLICANT PHONE » WITH AREA CODE <br />VE TYPE of APPLICATiCN Piping <br />O I (Closure, Installation, etc.g@pair <br />TOTAL <br />CI <br />PERMANENT <br />CLOSURE (Removal or Autnorizec �.iosure-,n-m ace; ' <br />:hn^ :.a. <br />L. <br />Oj <br />CLOSURE FEE <br />= 578.00/hour (3 hours minimum/TANK) I <br />» TANK(s) <br />l UI <br />TEMPORARY <br />CLOSURE (Plan Review & Inspections) I <br />TANK i.D. »(s)_ <br />R' <br />E! <br />TEMPORARY <br />CLOSURE FEE = 378.00/hour (3 hours minimum/FACILITY) i <br />$234.00 minimum <br />X 5234.00 = j $ <br />Pl INSTALLATION PLAN CHECK (Ptan Review & Construction inspections)) TANK I.D. »(s) <br />L <br />Al <br />NI PLAN CHECK FEE = 578.00/hour (8 hours minimun/FACILITY) = 5624.00 minimum S <br />Rj REPAIR FEE (Workplan Review & Construction Inspections) I TANK I.D. »(s) <br />�i <br />Pi TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) I » TANK(s) X 5234.00 = S <br />A <br />Ij TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) = 5234.00 minimum S <br />R; <br />i PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) = 5234.00 minimum S <br />i <br />MI TRANSFER FEE = 520.00 , UNAUTHORIZED RELEASE EVALUATION = 578.00/hr I S <br />I }— i I { <br />S' <br />C CONSULTATION FEE = 578.00/hr ! SAMPLING INSPECTICN r -EE = 578.00/hr ( i S <br />TOTAL DUE <br />FOR OFFICE USE ONLY <br />_ _ ...._.._ _._..._........- - _..........._...._...._.. _ __..._...._...._...._.__......._.......... _._ _ _ :..._ _ _.— -. �.� .._ _.. ......_............._ ....................... <br />SWEEPS » j COMPUTER j LOC CODE i DIST CODE { AMOUNT RECEIVED i CHECK »/CASH I RECEIVED 3Y DATE RECEIVED <br />__................ <br />=H 23 032 (REVISED 1-12-98) <br />