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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> t F FACILITY/SITE NAME FACILITY CONTACT NAME <br /> C STEVE RENTALS MR, ROBERT J. WHITMAN-OWNER (TECO) <br /> I -- -- — -- <br /> L STREET ADDRESS SITE PHONE 1 WITH ANNA tome <br /> T 275_E�QWLLQ E ROAD _ _ (209) 836-2547 <br /> Y CITYS1 Tp CODE 1 of Tanks <br /> TRACY ----�C� 955/6 at Site 1 (one) <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P THE ENVIRONMENTAL CONSTRUCTION COMPANY (TFCC) MR, ROBERT J. WHITMAN <br /> LRxTN ARtA Com[ <br /> I MAILING ADDRESS APPLICANT PHONE 1 <br /> (408) 997-1505 <br /> T CITY I STAT i1P'CODE I TYPE of AP <br /> ICATION <br /> SAN JOSE. CA 95112-44 CLotmRt, 1 TALLATIo", tTo. REMOVAL <br /> FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR - TOTAL <br /> A ...._. -...._.........._.__.-- _._._.... _. . ...__9-7---.- ._...._._-_....._.-._ — <br /> T 1986 1987 1988 - —1989 <br /> E TANK FEE _ $50.00 each TANK <br /> F 1 Tanks ( x 150.00 1986 1987 1988 1989-4 <br /> A (multiply 1 by lee for <br /> C each year applicable) - SO' SD — $O `— SO 1 oZ 00 <br /> I --- - -- <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH 6 SAFETY CODE Sec 25287 for applicability) <br /> T 1 Tanks !__ x 156.00 1986 1987 1988 1989 <br /> Y (enter Nount and year) <br /> CPERMANENT CLOSURE (Removal or Closure-in-place) - — <br /> 0 CLOSURE FEE = 190.00 each TANK 1 Tanks_____ x 140.00 1 q p <br /> S -- -- ---..__ <br /> 0 _--- --—- -- <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E TEMPORARY CLOSURE FEE = 180.00 each TANK — - 1 Tanks— x 180.00 1 <br /> P PLAN CHECK (installation or Repair) —--� <br /> L - — — -- ----- -- - ---- -- — <br /> A <br /> M PLAN CHECK FEE = 130.00 each SUBMISSION/RESUBMISSION 1 <br /> - <br /> REPAIR �_-_--------- — <br /> P, TANK REPAIR FEE = 1110.00 each TANK 1 Tanks _ x 1110.00 f <br /> F ----- <br /> A <br /> ..-A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> I -- ---- __..... _ ------ <br /> R UNAUTHORIIED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING IIISPECTION <br /> (when applicable) (when applicable) (when applicable) <br /> FEE = 130.00/hr FEE = 135.00/hr FEE - 135.00/hr 1 <br /> TOTAL DUE 1 — <br /> OFFICE USE ONLY <br /> '!�I°Ifl! <br /> ;WEEPS I COMP 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD HECK-C1/CASH RCVD BY DATE RECEIVED PERMIT 1 <br /> ...... rrI <br /> G� 3 <br /> t3�i° v �'' ,'�� �I�Pfl�lAnfl %M� �flmlprip,l ulflu�fl���mllfl�a�am� <br />