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5-26-1998 1:d8PM FROM <br />SAN JOAOUIN *Y PUBLIC HEALTH SERVICES - EAVIROWrjffAL AL.,DIVSION <br />UNDERGROINlD STORAGE TANK PROGRAM - FEE WORKSHEET <br />P_ d <br />S <br />FACILITY SITE NAME <br />FACILITY CONTACT NAME <br />E <br />E <br />FACILITY ADDRESS <br />SITE PHONE S with AREA CODE <br />a <br />3 <br />PLAN CHECK FEE = 578.001hour (8 hours miniwuWFACILITY) $624.00 minimum <br />f <br />CITY <br />STATE <br />TIP CODE <br /># of TANKS <br />A <br />P <br />_ <br />� rG <br />(, <br />at SITE 4 <br />5 <br />P <br />APPLICANT/BIL NG NAME <br />APPLICANT CONTACT NAME <br />L5eVVIyc. <br />ry Sr <br />W (fit 1 <br />C <br />MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />M�rT11 <br />ST. <br />'7 ► �9 <br />T <br />CITY <br />STATE <br />ZIP CODE <br />TYPE of APPLICATION <br />(Closure, Instatiation, etc.) <br />m6 f)— <br />TOTAL <br />C PERMANENT CLOSURE (Removat or Authorized CLosvre-in-Place) TANK I.D. *(s) <br />L <br />0 CLOSURE FEE = 579.00/hour (3 hours minimum/TANK) # TARK(S) X 5234.00 = S <br />S <br />U TEMPORARY CLOSURE (Plan Review L Inspections) TANK I.O. *(s) <br />R <br />E TEMPORARY CLOSURE FEE = S78.00/hour (3 hours minimum/FACILITY) $234.00 Minimum S <br />PINSTALLATION <br />PIAN CHECK (Ptan Review & Consrrucrion Inspections) TAMC <br />L <br />E <br />P <br />A <br /># TANK(s) X 5234.00: <br />S <br />N <br />PLAN CHECK FEE = 578.001hour (8 hours miniwuWFACILITY) $624.00 minimum <br />f <br />R <br />REPAIR FEE (Workplan Review & Construction Inspections) <br />TANK I.D. OKs) <br />E <br />P <br />TANK LINING REPAIR FEE = 578.00/hour (3 hours minieWTANK) <br /># TANK(s) X 5234.00: <br />S <br />A <br />I <br />TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILITY) = SM.00 minimum <br />$ <br />R <br />PIPING REPAIR FEE a 578.00/hour (3 hours miniMWFACILITY) S234.00 Minimum <br />5 <br />N TRANSFER FEE = $20.00 UNAUTHORIZED RELEASE EVALUATION = 578.00/hr <br />I <br />S <br />C CONSULTATION FEE = 578.00/hr # SAMPLING INSPECTION FEE = 578.00/hr <br />FOR OFFICE USE ONLY <br />.a- <br />SWEEPS * COMPUTER 0 i LOC COOT ! DIST CODE I AMOUNT RECEIVED J CNECK */GSM <br />RV` e.4,la4$ <br />s� <br />s <br />TOTAL DUE 5 �� <br />SY j DATE RECEIVED <br />