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SAN JOAOUIN C Y PUBLIC HEALTH SERVICES - EIVIRCNME.VTAL N%OdTH DIVSION <br />UbW§GRCUHO STORAGE TANK PRCGRAM - FEE LCRKSHEET <br />SI <br />FACILITY SITE NAME <br />(Removal or Au"oriiec Closure-in-Ptaca) <br />TANK 7.0. <br />FACILITY CONTACT NAME <br />TI <br />Air Port Way Lube Center <br />Raymond Lopez <br />E <br />FACILITY ADDRESS <br />Y TANKS; <br />1 X 5234,00 = <br />SITE PHONE X wi N AREA CCOE <br />442 N. Air Port <br />Way <br />(209)462-0253 <br />a <br />(Plan Review 3 Inseecciers) <br />TANK I.D. <br />#(s) <br />R• <br />CITY <br />STATE! <br />ZIP CODE <br />x of TANKS <br />A <br />Stockton <br />CAI <br />95205 <br />a: sI E <br />P <br />1 <br />P <br />WE <br />APPLICANT CONTACT NAME <br />L <br />Raymond Lopez <br />Raymond Lopez <br />I <br />MAILING AOCRESS <br />APPLICANT PHCNE ! 'JITH AREA CODE <br />AlCj <br />R <br />442 N. Air Port <br />Way <br />(209)462-0253 <br />Ti <br />CITY <br />STATE! <br />ZIP CODE TYPE of APPLICAT(CN <br />I <br />Stockton, <br />I CA <br />I (Closure, Ins:a(La:icn, et_.) Removal <br />TOTAL <br />Ci PERMANENT <br />CLOSURE <br />(Removal or Au"oriiec Closure-in-Ptaca) <br />TANK 7.0. <br />R(s) <br />L i <br />W CLOSURE FEE = 578.00/hcur (3 hours minimus/TANK) <br />Y TANKS; <br />1 X 5234,00 = <br />S. <br />— <br />UI TEMPCRARY <br />CLOSURE <br />(Plan Review 3 Inseecciers) <br />TANK I.D. <br />#(s) <br />R• <br />Ei TENPCRARY <br />CLOSURE <br />FEE = 578.00/hour (3 hours minimum/FACILITY) 1 <br />$234.00 mininiuo <br />INSTALLA7:CN 'LAN CHECK (P!an Review 3 Canscruc:ion !nseec:'ons)! TANK i.0. 9(s) <br />s234.00 <br />S <br />NI PLAN CHECK FEE = 578.00/hcur (S hours minimus/FAC:L:TY) = S6Z4.00 minin-T I S <br />Ml TRANSFER FEE = 520.00 UNAUTHCRIZED RELEASE EVALUAT:CA = 578.00/hr I 3 1 <br />S: <br />C: :CNSc LTATICN F_- = 378.00/hr SAMPLING INSPECT:CN FEE = S78.CC/hr 5 <br />TOTAL DUE ' $234.00 <br />FCR CF=RCE USE: ONLY <br />._...' <br />SaE?S � C_MPU7-3 X <br />CCCE AMOUNT RECT:VED C3ECK :/CASH <br />!S <br />