Laserfiche WebLink
a` RKW A u G ram �,_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> -- <br /> If FACILITY SITE NAME FACILITY CONTACT NAME. <br /> fn <br /> I RAY JETT <br /> it <br /> L STREET ADDRESS SITE PHONE a WITH A09A coot <br /> 1 <br /> 1 17855 S . COMCONEX 209_) 239-0208 <br /> Y CITY STATE 11P CODE 1 of Tanks <br /> MANTECA CA 95336 at Site 2 <br /> A APPLICANT/BILLING NAME <br /> P APPLICANT CONTACT NAME <br /> P GROUNDWATER RESOURCES , INC. (GRI) A . FAMIREZ <br /> L _ _ <br /> I NAILING ADDRESS _— APPLICANT PHONE 1 WITH AAIA cane <br /> r. <br /> A P 0 . BOX 9383 . BAKERSFIELD. CA <br /> N City — I-- --_1$05 835-7700 <br /> I STAT TIP CODE TYPE of APPLICATION - <br /> BAKERSFIELD - CA 93389 -- 010iU"= '"•=A'-`A=Ion, nc' CLOSURE <br /> FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR ----_ <br /> TOTAL <br /> C 1906 1907 1908 1909 <br /> T ----- <br /> I <br /> V <br /> E TANK FEE = 150.60 each TANK -- - <br /> F 1 Tants s 150.00 <br /> A (multipEy-lby lee for1906P S <br /> 1900 1909 <br /> - — <br /> C each year applicable) — ---— <br /> 1 1 <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH <br /> I V SAFETY CODE Sec 25207 for applicability) <br /> I 1 Tanks , S56.00 1906 1907 1900 1909 - <br /> Y (enter iiount and year) <br /> C PERMANENT CLOSURE (Removal or Closure-in-place! REMOVAL <br /> L -- <br /> 0 CLOSURE FEE = 190.00 each TANK _ --x19 — <br /> S 1 Tanks 2_ s 190.00 1 180. 00 <br /> U . <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E <br /> TEMPORARY CLOSUP,E FEE x 1BOG0. each TANK -- - — — -- — <br /> - �1 Tanks.^� a 190.00 <br /> P PLAN CHECK (installation or Repair) - --- <br /> L --_ _ - <br /> A -- <br /> 11 PLAN CHECK FEE = 170.00 each SUBNISSION/kESUCMISSIOII <br /> REPAIR —' ---- - --- .... <br /> P TANK, REPAIR FEE = 1110.00 each TANK -- <br /> E - 1 Tanksr 1110.00 1 <br /> A PIPING REPAIR/CLOSURE/REMOVAL flees are per hour, minimum one how to be paid on plan submittal) <br /> I '---IRETLEA�SE <br /> R UNAUTHORIZEEVALUATIONCONSTRUCTION INSPECTION SAMPLING INSPECTION(when applic (when applicable) (when applicable) <br /> FEE = 130 00 — FEE = 105,00/1ir� -_ -- -'------ <br /> FEE = 135.00/hr — 1 <br /> 1 180 . 00 <br /> OFFICE USE OILY TOTAL DUE _ — <br /> 1 f u "G�"D U CU I GIIVi�UI�IWUY°:ffjj1 1�°QV�419fV!d]E�IV11Cl �p&91ll1rJ�J�Id�VC��V�160CVR <br /> SWEEPS 1 COMP 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK 1/CASH I RCVO DY DATE P.ECEIVEO PEP.NIT r <br /> yygqwpIl�o����p; �r Ji�VS316�IdeYJll ��ltJ[ i GI�V9IpID"V�.WL ..._._..---- ----__....__.___ ._....--- ---------.---- ------ <br /> C �1TU97"VV A ��7D a ° � +�^�V9C@UIII� " �IifJ9CVU pI� �uVVCV'1llV�I�k�I1VWI�II�IVVVVa�121 �1VUQhV�VWUV�Gi18VWViGni;PN�O�Ja <br />