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SAN JUAUUIN LOCAL HEALTH DISTi21CT ' <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> kF� YlSITE NAME FACILITY CONTACT NAME <br /> Buffalo Tank Corporation Robert Sarti , P1anager <br /> DDRESS SITE PHONE t (with Area Code) <br /> 5709 E. Fremont Street (7.09) 931-0373 <br /> STATE IIP CODE t of TANK'S <br /> STockton, CA _ at Site2 <br /> TIBILLING NAME APPLICANT CONTACT NAMEBuffalo Tank Corporation Robert Sarti <br /> ADDRESSP0. Box 55286 APPLICANT PHONE t (with Area Code) <br /> — 209 931-0373 <br /> STA1E TIP CODE TYPE of APPLICATION Tank Removal <br /> Stockton, — C. 95205 <br /> (Closure, Installation, etc.) <br /> rFEE <br /> 100.00 each SIZE ADDRESS per YEAR — —� TOTAL <br /> s00 each TANK T— <br /> f 1 Tanks r (50.00 1986 — 1987 1988 <br /> A (each yea tape fee Tor — �— L_ <br /> C tads yea: applicable) <br /> L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH i SAFETY CODE Sec 25187 for app§qW'dWENTAL HFAI TH _ <br /> 1 --- <br /> T t Tanks r $56.00 1986 1987 1988 1989 PERMITISERV CES <br /> Y (enter iiount and year) _ <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) — <br /> L — —. — <br /> 0 CLOSURE FEE = 130.00 each TANK 1 Tanks 2 r 190.00 1 180.00 <br /> S -- -- - <br /> U — — — — <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E <br /> TEMPORARY CLOSURE FEE _ $80.00 each TANK t Tanksx $80.00'_.-- <br /> P PLAN CHECK (Installation or Repair) <br /> L _ <br /> N PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION f <br /> REPAIR — — -- — ----r--- — �I <br /> R — -- — <br /> EE TANK REPAIR,, FEE = 1110.00 each TANK t Tanks x $110.00 1 <br /> -- —. <br /> A -- — -- — -- --- <br /> RI PIPING REPAIRICLOSURE/REMOVAL (Fees are per hour, minimum one hour to he paid on plan submittal) <br /> UMAUTHUR RED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE = 130.00/hr FEE _ $35.00/hr FEE = S35.001hrl — f <br /> TOTAL DUE Is <br /> OFFICE USE ONLr <br /> SWEEPS t COMP 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK I/CASH RCVO BY DATE RECEIVED PERMIT 1 <br /> x5i InV011 <br /> 57b- <br /> ti- <br />