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SAN JNvAQUIN COUNTY PUBLIC HE...aTH SERVICES UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET ACILITY/SITE NAME ACILITY CONTACT NAME Kid Cody' s TREET ADDRESS ITE PHONE # WITH AREA CODE 30600 S . Corral Hollow ITY TATE IP CODE of Tanks Tracy, CA t Site PPLICANT/BILLING NAME PPLICANT CONTACT NA14E 1 4AILING ADDRESS PPLICANT PHONE # WITH AREA CODE ITY TATE IP CODE YPE of APPLICATION LOSURE, INSTALLATION, ETC. ACILITY FEE = $100.00 each SITE ADDRESS per YEAR TOTAL 1986 1987 1988 1989 Iqqn 1I Paid 1 $1()0 . 001 100 . 001 100 . 00 1100 . 00 S400 . 00 TANK FEE = $50.00 each TANK 100% Penalty For 1990 fees $500 . 00 # Tanks 8 x 850.00 1986 00 f 19 7venrT1 mu ttipLy # by—fee for each year applicabte) Paid 1 400 . 00 1400 . 00 400 . 00 1 400 . 00 1 , 600 . 00 I TATE SURCHARGE = 856.00 each TANK (see CA HEALTH 8 SAFETY CODE Sec 25287 for applicability) 1 Tanks x $56.00 1986 1987 1988 1989 enter amount and year) Paid ERMANENT CLOSURE (Removal or Closure-in-place) LOSURE FEE = $90.00 each TANK # Tanks x 590.00 EMPORARY CLOSURE (Only allowed one time for up to two years) TEMPORARY CLOSURE FEE = 880.00 each TANK # Tanks x $80.00 LAN CHECK (Installation or Repair) LAN CHECK FEE = 830.00 each SUBMISSION/RESUBMISSION REPAIR TANK REPAIR FEE = 8110.00 each TANK # Tanks x 8110.00 (PING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) 1 NAUTHORIZED RELEASE EVALUATION ONSTRUCTION INSPECTIONMPLING INSPECTION when applicable) when applicable) when applicable) EE = $3 IFEE = 835.00/hr I IFEE = 835.00/hr TOTAL DUE 3 0 0 6 . 0 0 OFFICE USE ONLY ___________ ______________________ __________@--�___------------------------------ a__@a mu mu._.m am SWEEPS # COMP # LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK #/CASH RCVD BY DATE RECEIVED PERMIT # C n � _ �_�_�_� _______________ _ _Q_a__@__Q�_�_a__�_uuaiauaiau�uaaisuaau�im