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SAN JOACUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH OIVSION <br />UNDERGjW STORAGE TANK PROGRAM - FEE WORKSHEET i <br />(FACILITY <br />SITE NAME i (; <br />/ <br />FACI IT ONTAL tE ' <br />1987 <br />1988 11989 <br />1990 <br />T <br />E <br />FACILITY ADDRESS <br />SIT PH E with AREA C E <br />& <br />A <br />CITY <br />v <br />CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) <br />E <br />ZIP CODE 0 of TANKS <br />Fat SITE <br />XXXX <br />XXXX <br />XXXX I XXXX <br />XXXX S XXXXXXXX <br />S <br />P <br />P <br />APPLICANT/BILLING NAME APPLICANT NTACT NAM <br />1989 <br />1990 <br />1991 <br />C <br />C <br />MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br />1a2� <br />Ml <br />o <br />T <br />CITY <br />I Sl <br />ZIP CODE <br />TYPE of APPLICATION G�i� ULA✓ <br />XXXX I XXXX <br />XXXX S XXXXXXXX <br />I <br />(Closure, Installation, etc. a r' <br />TOTAL <br />V <br />TANK FEE = S50.00/TANK (Prior to January 1,1991) <br />1986 <br />1987 <br />1988 11989 <br />1990 <br />E <br />ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 <br />ANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = $234.00 minimum <br />$ <br />0 <br />CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) <br />A <br />5 <br />XXXX <br />XXXX <br />XXXX I XXXX <br />XXXX S XXXXXXXX <br />S <br /># Tanks = <br />1988 <br />1989 <br />1990 <br />1991 <br />C <br />1993 <br />1994 <br />1995 <br />1996 1997 <br />1998 <br />T <br />FACILITY PENALTY FEES ASSESSED (If Applicable) <br />XXXX <br />XXXX <br />XXXX I XXXX <br />XXXX S XXXXXXXX <br />I <br />V <br />TANK FEE = S50.00/TANK (Prior to January 1,1991) <br />5170/TANK (After January 1, 1991) <br />P <br />T NK LINING REPAIR FEE = S78.00/hour (3 hours minimum/TANK) <br /># TANK(s) X $234.00 = <br />E <br />IIIR <br />ANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = $234.00 minimum <br />$ <br />0 <br />CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) <br /># TANK(s) X 5234.00 = <br />5 <br />S <br /># Tanks = <br />1988 <br />1989 <br />1990 <br />1991 <br />1992 <br />1993 <br />1994 <br />1995 <br />1996 1997 <br />1998 <br />F <br />(multiply # by fee for <br />TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/FACILITY) <br />5234.00 minimum <br />S <br />A <br />each year applicable) <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />I <br />S <br />C <br />I <br />TANK PENALTY FEES ASSESSED <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />XXXX <br />I <br />S <br />L <br />I <br />STATE SURCHARGE FOR NEW FACILITIES ONLY=518.50 S <br />T <br />Y <br /># Tanks x 58.00 <br />1988 through 1993 ($56) <br />1993 through 1997 (S56) <br />1998 <br />SURCHARGE FOR 1998 <br />XXXXXXXXXXXXXXXXXXXXXXXXXXX <br />XXXXXXXXXXXXXXXXXXXXXXX <br />S <br />C� <br />PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) <br />TANK I.D. #(s) <br />P <br />T NK LINING REPAIR FEE = S78.00/hour (3 hours minimum/TANK) <br /># TANK(s) X $234.00 = <br />L <br />IIIR <br />ANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = $234.00 minimum <br />$ <br />0 <br />CLOSURE FEE = S78.00/hour (3 hours minimum/TANK) <br /># TANK(s) X 5234.00 = <br />5 <br />S <br />U <br />TEMPORARY CLOSURE (Plan Review & Inspections) <br />TANK I.D. #(s) <br />R <br />E <br />TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/FACILITY) <br />5234.00 minimum <br />S <br />P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) TANK I.O. #(s) <br />L <br />A <br />N PLAN CHECK FEE = S78.00/hour (8 hours minimum/FACILITY) = S624.00 minimum TS <br />M TRANSFER FEE = S20.00 <br />I <br />S <br />C CONSULTATION FEE = S78.00/hr <br />FOR OFFICE USE ONLY <br />UNAUTHORIZED RELEASE EVALUATION = S78.00/hr <br />SAMPLING INSPECTION FEE = S78.00/hr <br />:.H 23 032 (REVISED 1-12-98) <br />PAIR FEE (Workplan Review & Construction Inspections) <br />TANK I.D. #(s) <br />P <br />T NK LINING REPAIR FEE = S78.00/hour (3 hours minimum/TANK) <br /># TANK(s) X $234.00 = <br />S <br />IIIR <br />ANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) = $234.00 minimum <br />$ <br />PIPING REPAIR FEE = S78.00/hour (3 hours minimum/FACILITY) = S234.00 minimum <br />S S/ <br />M TRANSFER FEE = S20.00 <br />I <br />S <br />C CONSULTATION FEE = S78.00/hr <br />FOR OFFICE USE ONLY <br />UNAUTHORIZED RELEASE EVALUATION = S78.00/hr <br />SAMPLING INSPECTION FEE = S78.00/hr <br />:.H 23 032 (REVISED 1-12-98) <br />