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VINeRUF'-�,/ w.nnVC •inn •n.n...�. .cc n......�..��. E[' <br /> dorFACILITY CONTACTr Mart Paul V. Sundberg <br /> E. Alpine Rd. SIZE PHONE / with AREA CODE N/A <br /> CITY STATE LIP CODE 1 of TANKS <br /> A Stockton, CA. 95204 at SITE 1 <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L New West Federal Savings and Loan Jodie Ambrose <br /> I <br /> C MAILING ADDRESS APPLICANT PHONE R WITH AREA CODE <br /> A 301 Commerce St. Suite 1450 (817)870-2255 <br /> N <br /> t CITY STATE LIP CODE TYPE of APPLICATION <br /> Fort Worth TX 76102 (Closure, Installation, ace.) Removal <br /> TOTAL <br /> 1966 1987 1988 1989 1990 <br /> h <br /> L fACIU TY TEE (Prior to Jenuery 1, 1991) • !100.00LITY PENALTY FEES ASSESSED (If Applicable) XXXX KXXKFEE + 550.00/TANK (Prior to January 1,1991) SI70/TANK (After January 1, 1991) <br /> nks + 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> tiply R by year applicable)PENALTY FEES ASSESSED XXXX XXXXE SURCHARGE • 556.00 each TANK (Due every 5 years) See California H d S Code, Section 25287 <br /> nks_ X 556.001986 through 1990 1991 through 1996 <br /> er amount and year) <br /> S <br /> C PERMANENT CLOSURE (Remove( or Authorl2ed Ctosure-in-Piece) TANK I.D. R(a) <br /> L <br /> 0 CLOSURE FEE + 178.00/hour (3 hours minimum/TANK) - R TANK(s) 1 X $234.00 • 1 234.00 <br /> S <br /> U TEMPORARY CLOSURE (Plan Review R Inspections) TANK I.D. R(a) <br /> R <br /> E TEMPORARY CLOSURE FEE • 178.00/hour (3 hours minimum/TANK) A TANK(%)_ X 1234.00 • f <br /> P INSTALLATION PLAN CHECK (Plan Review B Construe tion Inspections) TANK I.D. N(s) <br /> L <br /> A <br /> N PLAN CHECK FEE + 1um <br /> 78.00/hour (8 hours minim /FACILITY) • 5624.00 minimum 1 <br /> R REPAIR FEE (Workplan Review R Construction Inspections) TANK 1.0. R(s) <br /> E <br /> P TANK LINING REPAIR FEE + 578.00/hour 0 hours minimum/TANK) 0 TANK(s) X 5234.00 S <br /> A <br /> I TANK RETROFIT REPAIR FEE + 178.00/hour (3 hours min./FACILITY) • S234.00 minimum 1 <br /> A <br /> PIPING REPAIR FEE • 578.00/hour (3 hours minimum/FACILITY) + 5234.00 minimum 5 <br /> N TRANSFER FEE • S20.00 UNAUTHORIZED RELEASE EVALUATION • 178.00/hr 1 <br /> I <br /> 5 1 <br /> C CONSULTATION FEE + 578.00/hr SAMPLING INSPECTION FEE • S78.00/hr <br /> TOTAL _ =_�4�i+fib <br /> FOR OFFICE USE ONLY :.. <br /> AMOUNT <br /> ECEIV:wr'n' v m:mnH REC B AT R emn� <br /> SWEEPS A COMPUTER 1 LOC CODE DIST CODE AHWNT RECEIVED HECK CASH RECEIVED BY DATE RECEIVED <br /> S <br /> �p��Tbii:�im:. 1a. mS4�6 : .flJll*�m3:.=AUB'�'9Bi[�':k�ie[n�®a ILL6^'1& 'IMSIHh�'➢ ® WNCP ®=J �R. <br /> EN 23 012 (REVISED 11.1.92) Page 11 <br /> .ol <br />