Laserfiche WebLink
SAN,,.OAQUIN LOCAL HEALTH D1%SofRICT <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> �6 FACILITY/SITE NAME FACILITY CONTACT NAME <br /> C Kooyman Trucking, Inc. Jack Hill <br /> I <br /> L STREET ADDRESS SITE PHONE # wrTR AREA CODE <br /> 1 1340 West Charter Way 209 463-2500 <br /> Y CITY STAT IIP CODE # of Tanks <br /> _ Stockton I Cal-.--95201 at Site Two (2) <br /> AA APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P Telic Engineering- Corporation Thomas D. Franken <br /> L <br /> I <br /> MAILING ADDRESS APPLICANT PHONE # Ml TN AREA CODE <br /> A P. 0. Box 2076 Stockton, California 95201 209 465-2000 <br /> T CITY STAT ZIP'CODE PLICATION <br /> Stockton Ca 95201 CLOSURE, TALLATIDR. Ere. Closure <br /> A .FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR TOTAL <br /> C 1986 1987 1988 1989 <br /> T <br /> I f <br /> V <br /> E TANK FEE = 150.00 each TANK <br /> F # Tanks x (50.00 1986 1987 1988 1989 <br /> A (multipTy 1-by fee for <br /> ( each year applicable) $ <br /> L STATE SURCHARGE _ $56.00 each TANK (see CA HEALTH & SAFETY CODE Sec 25287 for applicability) <br /> I <br /> T 1 Tanks x $56.00 1986 1987 1988 1989 <br /> Y (enter iiount and year) <br /> S <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L <br /> O CLOSURE FEE _ $90.00 each TANK # Tanks---Z- x $90.00 $ 180.00 <br /> 5 <br /> U <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E <br /> TEMPORARY CLOSURE FEE _ $80.00 each TANK I Tanks —x $80.00 f <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> N PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUOMISSION $ <br /> REPAIR <br /> P. TANK REPAIR FEE _ $110.00 each TANK <br /> E # Tanks x $110.00 $ <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> I <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> When applicable) (when applicable) When applicable) <br /> FEE _ (30.00/hr FEE = $35.00/hr _ IFEE _ $35.00/hr $ <br /> TOTAL DUE s 180,00 <br /> OFFICE USE ONLY <br /> i <br /> SWEEPS t COMP I LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVO CHECK I/CASH RCVD BY DATE RECEIVED PEP.MIT t <br /> ,,,I <br />