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SAV JOAGU I N LOCAL I-ILAL'FI-I DIF TCT — <br /> — ---__ <br /> &..�GROUND STORAGE TANK PROGRAM FEE NORKSi <br /> IF�CILITY/SITE HANE ' -- <br /> FACILITY CONTACT NAPE <br /> - Brooks Products, Inc. <br /> 1 --------__..____--._...__ Gary Kapic 1 <br /> L ST.EET�ADORFSS ------------ <br /> f 2441 West Charter Way SITE PHONE t °'*' nREw cooE <br /> T- . - --- -- - (209) 464-7696 <br /> Y CITY __._. <br /> Stockton TATE t``P i'0DE , t of Tanks <br /> I CAI 952b6 at Site <br /> A APPLICANT/80.LIHG NAME <br /> P APPLICANT CONTACT NAME <br /> F Brooks Products, Inc. Gary Kapic <br /> -- - _ <br /> MAILING AOOP� 41 West charter Way APPLIC/4T 8 /E 14 4-'��9�ME <br /> NCIT? .......... -- J- __ ......_.._._._..--- ----- } <br /> T SihTF 71P r,ODE JSYfiE c.L APPLICATION 1 <br /> Stockton cLouuR E, IRBTnLIAIIIw, ETC. <br /> - - -- ._...- ._....... ---._._..... _._...._....G.A...-.I 95.2.06_......_:.__.. ._ <br /> ----- <br /> --- ------- <br /> fACILITY FEE = f100.0i' ezth SITE ADDRESS per YEAR -- i <br /> IAETAHK <br /> _ --- - -- - TOTAL <br /> C In86 1307 1988 I 1983 <br /> ........ _.._._.. ...__................._..._..._. - -- -- - <br /> t' s <br /> ....—_.,...EF = t50.(IU each iANf; ) <br /> F I Tanks _ x t50.00 iD6 UO) 990 iD1 - <br /> ultipTY F by Tee for <br /> C each-Year applitableK <br /> A % }} I --- <br /> 1 ..._._ <br /> r <br /> L STATE SURCHARGE - 5,,6.00 each TANK (see kA HEALTH L SAFETY CODE Set 25287 for applicability) <br /> -- - - ... ...---------- -- - <br /> i ( Tants - . c t56,00 1386 1901 1 1308 1369 <br /> 1 - <br /> Y (enter iiaunt :and year) ...- - --- -- .._..----- - ) <br /> $ <br /> ----- ----------------.._.... __......_ _......_.._......-_ - -- ) <br /> --- <br /> FPERWAXENT OSURE (kenoral ur Closure-in-plate) <br /> : t30,00 each• TANK t Tants--------- --------...--------__..........OSURE (Only alloyed one tine for up to tvo years) <br /> - - --..__........... ...... ...._ ..._ . . _.SURE FEE _ $v.00 [aciTANI: Tan]-:; 150.00 -- <br /> i <br /> $s <br /> t C <br /> .. . <br /> P PLAN CHECK (-Installation or Repair) ; <br /> IL <br /> ' --- -._............._.................. ..............-___-....__...._._...._... ---- - - --- — <br /> A . F <br /> M PLAN CNECY..FEE _ $30.00 each SUDNISSION/RESUDHISSfON <br /> --- --- - - <br /> -----------_------...__.._....__._._--------- <br /> ---=- ..._-._......_.......--..._.............._......--- <br /> kEPAIR - f <br /> L <br /> R TAN): REPAIR FEE _ $110.00 each TANK, II Tanks______ x 1110.00 t T <br /> E ----- -- .-:._ ......._...._................ ... ....... <br /> ... . . ..............._.................__..._........ - - -- - <br /> A PIPING REPAIP./CLOSUPVREMOVAL (Fees are per hour, Minimum one hour to be paid on plan submittal) <br /> 1 . <br /> ------ -- ....- -- - - - - ...- ---- - II <br /> R UNAUTHORIZED P,ELEASE.EVALUATI'ON CONSTRUCTION INSPECTION SAMPLING INSPECTION 4 <br /> (vhen•applitable) Nfien applicable) (vhen applicable) i <br /> ---- _......_.._...._._._............._.....-.....__...... <br /> - - <br /> "FEE : S30.OD)hr. FEE = 535.00/hr� FEE - f35.00/1r t , <br /> - - <br /> TOTAL DUE <br /> OFFICE USE OILY- y <br /> I i i y . <br /> $REEF$ I GP.MtUP,IUVUI.IIUIUI4.I�Uw!dI�IUNIUIIiIUUUUI!IIIIIIIIUUVII6UWIIUdIIIIUUI!IIHIIUIINUUUUUI!41QIUIUUI!fIUI� IIiiIN11NO 11'0000flymmill n <br /> 9P 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT RC'1D CHECK I/CASH i'-VD OY DATE P.ECEIVEO PERMIT I <br /> ., ,,, ,. � �,,, ,tr �'.�3IU'��� ,�aImUUPIIU?NIRA nil!�NBImUf�llPil!IIIi�P'14TH(lUGIUI'Itl!II!VU��UIIFNUIiflPIPN1U!IIINUII9UUI�UIIUIUIII000mIU IUflrm�mi�mm�oru, 1�99'm61gIImT,'m!f,'IItRn �.�� a <br />