Laserfiche WebLink
r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> - UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> ,FACILITY/SITE NAME FACILITY CONTACT NAME <br /> C Village Properties Blake Lambert <br /> 1 SITE PHONE 1 "IN AREA coos <br /> L STREET ADDRESS <br /> T 140 Harding Way 209-531-5489 <br /> Y CITY STATTIP CODE 1 of Tanks <br /> Stockton CA 95205 at Site ONE (1) <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P Don Lamb t & Sons, Inc. Blake Lambert <br /> I — <br /> I MAILING ADDRESS APPLICANT PHONE 1 "IT" AREA CODE <br /> C P. 0. Box 659 209-874-2168 <br /> A -- <br /> N CITY STAT ZIP'CODE civauof APPLICATIONO", erc. <br /> T Waterford, CA 95386 <br /> FACILITY FEE _ $100.00 each SIT ADDRESS per YEAR TOTAL <br /> A - - <br /> C 1986 1981 1 1988 1989 1990 <br /> T <br /> I 10 100 100 100 100 f 500 <br /> V <br /> E TANK FEE _ $50.00 each TANK <br /> F 1 Tanks x 150.00 1986 1987 1988 1989 1990 <br /> A (multiply-1-by fee for <br /> C each year applicable) 5050 50 50 50 f 250 <br /> 1 <br /> L STATE SURCHARGE _ $56.00 each TANK (see CA HEAL 4 SAFETY CODE Sec 25287 for applicability) <br /> I <br /> T 1 Tanks x $56.00 1986 17 1988 1 1989 <br /> Y (enter iiount and year) — <br /> S 56 <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L UU <br /> - <br /> 0 CLOSURE FEE _ -each TANK 1 Tanks...... x 330x00 $159.00 $ 159 <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. 1 nks x $80.00 f <br /> P PLAN CHECK (installation or Repair) <br /> L -- - <br /> A <br /> N PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION f <br /> REPAIR <br /> P. TANK, REPAIR FEE _ $110.00 each TANK --- 1 Tanksx $110.00 f <br /> E- <br /> P --P - — - <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on pan submittal) <br /> I — <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECT N <br /> (when applicable)- (when applicable) (when applicable) <br /> FEE _ $30.00/hr _ FEE = 135.00/hr - FEE _ $35.00/hr f <br /> TOTAL E $ 965.00 <br /> OFFICE USE ONLY <br /> Lir'z'i <br /> i''l�.11"CERMI, �uMl�(�4UN FiA C�7 � "U J91ill i.":71B�0115509 �u�""�l�ia�I�iG11GII�I�I�L� �u�10�€1:1VJfVC�UJ � � I�k�C9GRE "V I�I�V?ilC�' 9S�"�-PS $ LOMP 1 LOC CODE DIST CODE AMOUIIT DUE O CHECK 1/CASH RCVD DY DATE ECEIVED PEP.MIT t <br /> kE ��U "I T9g CJS I�QG��.�JEG9�RM 0.RKE nimm-, '11 r l m u "w.9�W' mon'i <br />