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BAN JOAQUIN LOCAL HEALTH DISTRICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET ^I i <br /> F FACILITY/SITE NAME FACILITY CONTACT NAME <br /> A COIL DRAPERY SERVICE William Edwards <br /> C <br /> h Area Code) <br /> STREEti9o��ESESnterprise SITE PHON(209)t466-5371 <br /> i <br /> Y CITY Stockton, STATE 119 CODE 1 of TANK'S <br /> CA 95204 at Site 1 <br /> A APPLICANUBILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P same <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE 1 faith Area Code) <br /> C <br /> A <br /> N CITY STATE 11F CODE TYPE of APPLICATION Tank Removal <br /> I (Closure, Installation, etc.) <br /> FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR TOTAL <br /> C 1986 1987 1988 1989 <br /> _ r _ <br /> 64 <br /> RICH-MART 10686 <br /> JIM THORPE, DISTRIBUTOR OF QUALITY PRODUCTS <br /> 388-8175 482-4581 <br /> 351 NO. BECKMAN ROAD, P.O. BOX 357 <br /> LODI, CA 85241-0357 .� O SQIGM211 <br /> PAY .�yf— A9 9 <br /> rotate ORDER of $ 4 <br /> .V( <br /> 1 L41 <br /> OLLARS <br /> iomi oFria <br /> rn W.wd„n 0.ieai,u>sxa <br /> P PLAN CHECK (installation or Repair) <br /> L <br /> N PLAN CHECK FEE _ $30.00 each SUAMISSION/RESUBMISSION p AY M E KTRe <br /> $ <br /> REPAIR <br /> E TANK REPAIR FEE = 1110.00 loch TANK 1 Tanks a $110.00 $ <br /> P <br /> A <br /> I PIPING REPAIR/CLOSIREIREMOVAL (Fees are per hour, AiniluA one hour to beP�Id aw'Qkttal <br /> R UMAUTHORIIED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (vhen applicable) INSPECTION INSPECTION <br /> FEE = 130.00/hr FEE _ $35,00/hr FEE = 135.00/hr $ <br /> TOTAL DUE $ p� <br /> OFFICE OSE ONLY <br /> SWEEPSWEEPS I COMP ( LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVP CHECK 1/CASH RCVD BY DATE RECEIVED PERMIT 1 <br /> DO MIT-D )I �Z 906,1-0 ' 0 C- K �d <br /> S <br />