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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Flj00 /wyd ,r <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET T*05/sG SS <br /> FACILITY NAME <br /> FACILITY CONTACT NAME Ale <br /> Ra mond Investment Corporation John L. Cammack <br /> FACILITY ADDRESS ShT£PHONE#WITH AREA CODE <br /> ee <br /> 30 E. Channel Stree ( 209 )473-8787 <br /> STATE ZIP CODE #OF TANKS AT SITE <br /> Stockton CA 95202 <br /> APPLICANT BILLINI <br /> E APPLICANT CONTACT NAME <br /> Raymond Investment Coration Beverly N. Garcia <br /> APPLICANT MAILING ESS APPLICANT PHONE#WITH AREA CODE <br /> P. O. Box 567 209 466-8604 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE: <br /> Stockton, CA 95201 Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> 1997-2000 2001 2002 <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK ($170)X(#tanks)X(#of years applicable) <br /> $125 PER TANK AFTER FIRST TANK p s',<l <br /> AID 0 10 01 � lo <br /> v) <br /> $ v) <br /> TANK PENALTY ASSESSEDO 1 10 1 O �"f' O SOU 5 Op $ ( (,Sc <br /> TANK SURCHARGE=$10/TANK $ Q <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$17.50/FACILITY $ 1 -7,S y <br /> PERMANENTCLOSURE <br /> Removal or Permitted Closure in Place <br /> TANK ID#(s): CLOSURE FEE=$267/TANK #TANKS X$267= $ <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID#(s): TEMPORARY CLOSURE FEE=$267/FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> (Plan Chedc and ConsWction Inspections) _ <br /> TANK ID#(s): I PLAN CHECK FEE=$712/FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANKID# s : <br /> TANK LINING REPAIR FEE =$267/TANK #TANKS X$267= $ <br /> TANK RETROFIT REPAIR FEE =$267/FACILITY - $ <br /> PIPING REPAIR FEE =$267/FACILITY RECEIVED $ <br /> MISCELLANEOUS OCT <br /> -, <br /> TRANSFER FEE _ $20 SAN JOAQUIN COUNT'. $ <br /> CONSULTATION FEE _ $89/HOUR ENVIRONMENTAL HEALTH PM910N $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $891 HOUR $ <br /> SAMPLING INSPECTION FEE = $89/HOUR $ <br /> ALL FEES ARE BASED ON THE$89 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY 33>s-T u �1. 4 <br /> o <br /> SERVICE REQUESTS FACILITY ID I 4MOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED <br /> SR 3 ----sY /I S /C' I �4f Lek- <br /> /y O� <br /> EH 23 032(REVISED 8/17/02) � <br />