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LIUfY/SIfE NAME *40001 FACILITY CONTACT Nl1�.mw <br /> /JrMiMiTADDRESS <br /> of Tracy Firestation #2 Don M.?son <br /> SITE PHONE 1 Nx►N AASA coosGrantline Rd . (209 )835-9118 STATE IIP C DE 1 of Tanks CA S`- at Site one <br /> AA APPLICANT/BILLING NANE APPLICANT CONTACT NAME ;%rrpr,., <br /> P City of Tracy on ;Mason ?rs�•'�(y_ <br /> 1 MAILING ADDRESS APPLICANT PHONE 1 Nx►N ANSA coos <br /> A 325 u^. 1Ot`i St . (209 `836-1640 <br /> 1 CITY STATE IIP'CODE TYPE of APPLICATION <br /> Tracy C!1 953!•6 occmwAs, xNmTAcLATroN. ETC. Closure <br /> FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR TOTAL <br /> t 1986 1987 1988 1989 <br /> I f <br /> V <br /> E TANK FEE = 150.00 each TANK <br /> F 1 Tanks —1 150.00 1986 13B7� 1988 1989 <br /> A (multiply-I-by fee for <br /> C each year applicable) ��' 1 <br /> I <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH It SAFETY CODE Sec 25181 for applicability) <br /> T 1 Tanks m 156.00 -- 1986 1981 1988 1989 <br /> Y )enter iiouot and year) <br /> 1 <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L1---------._--- Remova <br /> _ <br /> 0 CLOSURE FEE _ (90.00 each TANK <br /> S 1 Tanks 1 x 190.00 1 90 . 00 <br /> — <br /> U ------- <br /> R rEMPORAPY CLOSURE (Only allowed one time for up to two years) <br /> EY CLOSURE FEE _ {BO,UO each TANK -1 Tanks x 180.00 1 <br /> P PLAN CHECK Ilnstallation or Repair) <br /> h - <br /> II PLAN CHECK FEE - 130,00 each SUBMISSION/RESUOMISSION f <br /> REPAIR <br /> P, TANK REPAIR FEE _ 1110.00 each TANK _-- — Y Tanks______ x 1110.00 f <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 S <br /> TOTAL DUE 1190 . 00 <br /> OFFICE USE ONLY <br /> R'RIMM iuniff llun!.999089�RI�111�II Ipg� V9roi8a l� 3MIN . 9M�llfiIiVW� E mmlil licn,I •!MV@� 11011 I�k9VB�klQ HIMEM WOI�I�IIMIV1�u!IHII@G� <br /> 0PLOC Cf10E CODE_ AMOUNT DUE l 1�6P,AMOUNT RCVi�PNM�9GV� CHECK 1/CASH RCVD BY GATE RECEIVED PERMIT 1 <br /> � _ -------- <br /> EII NN .���1711I,IIVP,ppIli111111' f��I IIOISIi INil�l�lp��V�l �Q��1��0�i NI�I�1IlA0��1!@���I 0!�(I�Fl!ilSllll!.QI��IA@�Il�li� <br />