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_ <br /> 04-03 X001 06140HM FR01'' 3691651 P.01,,,,,cnvwc5-tNVIRUNMe/ _HEALTHD:VISic)N <br /> p <br /> UNDERGR,,,jND STORAGE TANK PROGRAM FEE KS FA <br /> FACILITY NAM FACRfTf CONTACT NAME <br /> The Cit of Stock on (209)937-8320 <br /> FACILITY ADC E56 ITF PHONE OF WTfN AREAC DE <br /> The right of way adjacent to 333 N. unt r St . <br /> G. STATE P CODE i 9 OF ANKS� qT 817E <br /> Stockton, CA 1 95202 2 <br /> APPLICANTIJILLINGNAME APPLICANT CONTACT NAME <br /> .The City of 8torkt�n I Ron Palmquist <br /> APPUCANTNAILIKG ADbRESS I APPLICANT PHONE*WITH AREA CODE —� <br /> 305 N. E1 Dorado St . • 209) 937-8320 <br /> CITY STATE ZIP CODE I CI L WORK TO BE DONE: <br /> Stockton , CA 95202 Closure n,taAaCDn Reperr Re"ft <br /> ACTNE FACILITY ' <br /> 1996-1999 2000 2001 <br /> $600 FEE INCLUDES FACILITY FEE+ I TANK ($17C}X(�tanks)X(M pf •a a dppl npb) <br /> $125 PER TANK AFTER FIRST TANK `�— I $ <br /> TANK PENALTY ASSESSED N�/1� <br /> TANK SURCHARGE•48!TANK I <br /> $ ,D� <br /> + $ <br /> ESTATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN 4 CUPA PROGRAM o 5'0 i FACJUTY <br /> PERMANENT CLOSURE <br /> ROMOV21 Or Permitted Clos re In Pram <br /> TANK ID# s : 2 I CLOSURE FEES a$261!TANK I 4TANKS X$261 - $ 5 •OO <br /> TEMPORARY OL SURE <br /> Plan Rwlew and! -Ona <br /> TANK 0#(s;; TEMPORARY CLOSURE FEE:$261 /FACILITY $ <br /> INSTALLATION HECK <br /> Plan Check and 00mtrvct Ins cdona <br /> PLAN CHECK FEE z$696!FACILITY $ <br /> RlPAIR7PLANNC KTANK IDTANK LIPPoR PEE n$281!TANK $261TAMC RREPAIR PEE _$261 /FACILITY <br /> PENS)REPAIR FEE $2611 FACILITY I $ <br /> MI CEU./W US <br /> TRANSF R FEE . $20 $ <br /> CONSULTAT,ON FEE • $ /HOUR $ <br /> UNAUTHORIZE RELEASE EVALUATION FEE = S 87!HCUR $ <br /> SAMPLING INSFIEC-KCN FEE . $8T/HOUR $ <br /> ALL FESS RE EASED ON TH[$87MZUR Y R_ TI E AT EEDS FE[SPAID W,LL EE VUZD TO,1?aLI C:Fu, <br /> OFFICE USE ONLY <br /> 3ERY SgTe FACILITY ID AMOUNT R[CEN50 SR CHECK a RE�IY[D 8 <br /> T9 RE VED <br /> �osr rRl<vl I <br /> TOTRL P.01 <br />