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FEB-02-04 17:27 FROM-KLEEMAN ROEBBELEN 916-939-1169 T-746 P.04/17 F-539 <br /> SAN JOAC, COUNTY ENVIRONMENTAL HEALTH DEPAR' NT <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WMKSHE"ECfnF,Q) <br /> 2nn <br /> FACILITY ME FACILITY CONTACT AME �'IJ v LL� <br /> Sec/PRcieie end- c4sA&V4 c4uz- 1 0 2 4 <br /> FACILITY S SITE PHONE#WITH AREA COPE <br /> 76 4 ¢ •v. 4SH46Y 1-44167' O - 9+ PE j H ALTH <br /> CITY I STA ZIP CODE. #OP TANKS ATS S <br /> S M uc TV Ae' CA R520j ONE <br /> APPLICANT BILLING NAME I APP CANT CONTACT NAME <br /> saG I Gases. Z <br /> APPLICANT MAILING ADDRESS I APPLICANT PHONE#WITH AREA COOP <br /> 37o7 4t 19 <br /> G1TY S A ZIP CODE CIRCLE WORK TO OF PONE! <br /> S's}eRA-roCN>� G+t{ `j 585/ Haar natalladon Repair Runt <br /> ACVI FACILITY <br /> 1995 1999 2000 2001 2002 2003 <br /> $500 FEE INCLUDES FACILITY FEE*1 TANK ILtto+xt>�eA IStrWxlrAenxaf <br /> $925 PER TANK AFTER FIRST TANK $ <br /> TANK PENALTY ASSESSED <br /> $ <br /> TANK SURCHARGE_$10/TANK <br /> STATE SURCHARGE.FOR FACILITES NOT ALREADY ON INVENTORY IN A COPA PROGRAM-517.501 FACILITY <br /> PERMANL!NTCLOSURE <br /> Removal or Permitted Clasuro in Plan <br /> TANK 10# S ' CLOSURE FEE=S2 9/TANK 9TANKS X 79- $a7q <br /> TEMPORARY CLOSURE <br /> Plan Review And I s etlOns <br /> TANK ID#(a): TEMPORARY CLOSURE FEE-$279/FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Cheek and Construction Inspections)- <br /> TANK <br /> nspections -TANK ID#(s)• -PLAN CHECK FEE=$744/FACILITY <br /> • 0000 <br /> REPAIR PLAN CHECK <br /> A s : <br /> TANK RETROFIT REPAIR FEE a$279 I FACILITY use for monflown agWOMSM.a ill Duckels.tank sumps.MISC, <br /> PIPING REPAIR FEE _$279 I FACILITY (use for piong.under-lf ser contOInment.act. <br /> MI$CELLANEOLIB <br /> TRANSFER FEE _ $20 <br /> CONSULTATION FEE = S 931 HOUR <br /> UNAUTHORIZED RELEASE EVALUATION FEE - 593/HOUR <br /> SAMPLING INSPECTION FEE $931 H <br /> ALL FEES ARE EASED ON THE 983 HOU LY TE. E THAT 6 8 PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVIC R 578 A 1 OU R NE0 CHECK# I RECEIVED BY PATE RECENEP <br /> SR <br /> 15m oz?(xcv13=p0101 0]) <br /> RECEIVED FEB-11-04 15:09 FROM-9168581011 TO-KLEEMAN ROEBBELEN PAGE 02 <br />