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SAN 10AQUIN LOCAL HEALTH DISTRICT <br /> QBROUND STORAGE TANK PR06RAN - FEE WORKSHE( <br /> F FACILITY/SITE NAME FACILITY CONTACT NAME <br /> C MCI TELECOMMUNICATIONS CORPORATION E. L. Phillips (209) 951 -8177 <br /> I <br /> L <br /> I STREET ADDRESS 28499 S. Corral Hollow Road SITE PHONE ! (with Area Code) <br /> T <br /> Y CITY Tracy STATE IIP CODE 11 of <br /> TANK'S 1 <br /> CA at <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P MCI TELECOMMUNICATIONS CORPORATION <br /> L <br /> I MAILING ADDRESS 400 International Parkway APPLICANT PHONE 1 (with Area Code) <br /> C 214 783-4900 <br /> A <br /> N CITY STATE TIP CODE TYPE of APPLICATION Tank Removal <br /> T Richardson Texa 75081 (Closure, Installation, etc.) <br /> FACILITY FEE = $100.00 each SITE ADDRESS per YEAR TOTAL <br /> A <br /> T 1986 1987 1 1988 1989 <br /> 1 t <br /> V <br /> E TANK FEE = S50.00 each TANK <br /> F 1 Tanks _ x $50.00 1986 1987 1988 1989 <br /> A (multiply 1-by fee for <br /> C each year applicable) f <br /> I <br /> L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH t SAFETY CODE Sec 25287 for applicability) <br /> I <br /> T 1 Tanks x $56.00 1986 1987 1988 1989 <br /> Y (enter iiii iA and year) <br /> f <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L <br /> 0 5 <br /> CLOSURE FEE = 590.00 each TANK 1 Tanks 1 x 190.00 S 90.00 <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 1 Tanks x $80.00 t <br /> P PLAM CHECK (Installation or Repair) <br /> L <br /> A <br /> N PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION S <br /> REPAIR <br /> P. <br /> E TANK REPAIR FEE = St10.00 each TANK 1 Tanks x $110.00 $ <br /> P <br /> A <br /> R PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE = 130.00/hr FEE = $35.00/hr FEE = $35.00/hr t <br /> TOTAL DUE 1 <br /> OFFICE USE ONLY <br /> ZUJZ <br /> OMP ! LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK 1/CASH RCVO BY DATE RECEIVES PERM11 t <br /> MCL 7& 4fz/ �0 �p�' <br /> ZJ a <br />