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SAN JOAQUIN LIC HEALTH SERVICES - ENVIR AL NEA IVSION <br />* AND kD STORAGE TANK PR - FEE WORKSHEET <br />S <br />FACILITY SITE NAME <br />f FACILITY CONTACT NAME <br />I <br />AT&T <br />T <br />'E <br />FACILITY ADDRESS <br />SITE PHONE with AREA CODE <br />110 West Turner Road <br />CITY STATE <br />ZIP CODE I of tANKS <br />A <br />Lodi CA <br />at SITE 1 <br />-7 <br />P <br />P <br />APPLICANT/3ILLING NAME <br />APPLICANT CONTACT NAME <br />L <br />Kvaerner Aronson, Inc. <br />Gary Nygren <br />I <br />C <br />MAILING ADDRESS <br />APPLICANT PHONE 9 WITH AREA CODE <br />A <br />11297 Coloma Road <br />916-631-1646 <br />N <br />T <br />CITY <br />STATE ZIP CODE <br />TYPE of APPLICATION Closure: <br />Rancho Cordova <br />CA ( 95670 <br />(Closure, Installation, etc.) <br />IUTA8. <br />CI PERMANENT CLOSURE (Removal or Authorized Closure - in -Place) <br />L <br />OI CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) <br />S <br />U TEMPORARY CLOSURE (Plan Review & Inspections) <br />R <br />El TEMPORARY CLOSURE FEE = 578.00/hour (3 hours minimum/FACILITY) <br />TANK I.D. T(s) <br />N TANK(s) 1 x $234.00 = S 234.00 <br />TANK I.D. +(s) <br />5234.00 minimum S <br />PI INSTALLATICN PLAN CHECK (Plan Review & Construction inspections) TANK I.O. T(s) <br />L <br />A <br />NI PLAN CHECK FE_ = S78.00/hour (8 hours minimum/FACILITY) = S624.00 minimum S <br />RI REPAIR FEE ('workplan Review & Construction Inspections) <br />E <br />P TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) <br />A <br />I TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) <br />R <br />PIPING REPAIR FEE = 578.00/hour (3 hours minimum/FACILITY) <br />TANK i.D. T(S) <br />4 TANK(s) X 5234.00 = s <br />= s234.00 minimum S <br />= 3234.00 minimum I 5 <br />MI TRANSFER FEE = 520.00 ' i UNAUTHORIZED RELEASEE EVALUATION = 378.00/hr 5 <br />i � I <br />S' <br />C CONSULTATICN FEE = 378.00/hr l I SAMPLING INSPECTION FEE = S78.00/hr 5 <br />TOTAL DUE 5 234.00 <br />FOR OFFICE USE ONLY --- <br />-... _..__ _ _____...__—_.__._—.___.. _..........._. ..._......—__.._� ___... �_ _ — — _ _ .......___ <br />SWEEPS • -� -:::: � :-::::� •-.-:_- �� _-:::::-:--�::—:::-•= = �-:-a•�� =-- ---=---:�::-�� ._.__... . <br />- 4. COMPUTER m 1 LOC CODEvI DIST CODE I AMOUNT RECEIVED I CHECK VCASH RECEIVED 3Y DATE RECEIVED <br />5 ! --- - <br />EH 23 032 (REVISED 11-12-98) <br />