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SAN AQUIN LOCAL HEALTH DI! <br /> J2ICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> F FACILITY/SITE NAME FACILITY CONTACT NAME <br /> A <br /> C Regal/ Wickland Oil 11604 Regal 11604 <br /> L STREET ADDRESS SITE PHONE I "T" ANEA COOK <br /> T -1448N_ E1 Dorado _— closed <br /> Y CITY - ------_--__-- ST�TtI ZIP CODE t of Tanks <br /> Stockton, al at Site 5-5,000 gal. tanks <br /> AA APPLICANT/BILLING NAME J APPLICANT CONTACT NAME <br /> P Town and Country Contractors Inc. John Savidge <br /> L —---------- ----... -- --- __-._._...._-.._— <br /> II MAILING ADDRESS APPLICANT PHONE 1 WITH ANSA cooE <br /> 117 Otto Circle, Sac. Ca. (916)392-1860 <br /> A -- <br /> M CITY STATZIP CODE TYPE of APPLICATION <br /> T Sacramento (Ia 95822. CLOSURE, INSTALLATION, ETC. closure <br /> FACILITY FEE = $100.00 each SITE ADDRESS per YEAR TOTAL <br /> A .._-...---------- <br /> ........ -----E <br /> _ <br /> T 986 1987 1988 1989 <br /> l f <br /> V _ --- — 88 ----9 -- <br /> E TANK FEE _ $50.00 each TANK <br /> - ._........_......_...---...-------- -.I_ <br /> —_ - <br /> F t Tanks s 150.00 1986 1987 1988 1989 <br /> ---------- <br /> A (multipT I-by fee for --I <br /> ---- -- <br /> C each year applicable) f <br /> I -------- --- <br /> L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH It SAFETY CODE Sec 25287 for applicability) <br /> T 1 Tanks r 156.00 198b 1987 1988 1989 <br /> Y (enter ii666t and year) --•-•----- -- - --------- <br /> --._._.... --.v...-._... --- ----- ---- <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L - <br /> 0 CLOSURE FEE _ $90.00 each TANK I Tanks5x 190.00 f 450.00 <br /> S ------- <br /> U .. ------- - ... ---- <br /> E TEMPORARY CLOSURE (Only alloyed one time for up to two years) - <br /> TEMPORARY CLOSURE FEE = $80.00 each TANK TI Tanks______ x $80.00 f <br /> P PLAN CHECK (Installation or Repair) <br /> L --- �...- ------ - --- - — <br /> h <br /> tl PLAN CHECK FEE = 130,00 each SUBMIS510N/kESUCMISSION f <br /> _ <br /> REPAIR <br /> P, TANK REPAIR FEE _ $110.00 each TANK f Tanks _ x $110.00 f <br /> P — <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (when applicable) (when applicable) - (when applicable) <br /> FEE (30.00/hr FEE = 135.00/hr FEE $35.00/hr f <br /> TOTAL DUE is <br /> OFFICE USE ONLY <br /> "!flIP�" .INPSE%gPPIIPSI!pP."PIMP!P011M.F..1!I, IPIIPfIIiIN9PI�fIH1PIT MORI 91BlAIII.Ill�I°TVVI IMPX@Pry PUPPP �!1C <br /> I <br /> DUE CRGVD DDATE <br /> al1EEPS.f_.. r Ct�I LOC en O�@E pDpIIIrySI T CODE I�A�N�OIU�IIpTAMOUNT RCVD HECK I/CASH Y RECEIVED PERMIT�p Dry'In� ����----,-• O1An, p��IIO�IO�I �I�I�O�p <br /> ! TliiD� � SIM18 It� ��Hy( �i��!, ryN104 141!L4111iP I::.!SII ILII""'PILI')l'll�:,l:i!I;.!dill!u�llllllll!I!IIIiI1N0IIIIPI!1 . III';III. tlll!R!111411!!'! ...I 1991MApEMtl!'LN i 1 <br /> E4 L7 U3�"FE�st�P (.itl� <br />