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SAM Jr 1;1U I N LOCAL HEALTH ©I STIV CT �,� <br /> UNOUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> A <br /> WILITY1111E NAME FACILITY CONTACT NAME <br /> C SAN JOAQUIN DELTA COIyT,F.f;F BOB yRIBpRREN <br /> I <br /> 11 STREET AIiIRESS SITE PHONE 6 <br /> 5151 PACIFIC AVENUE (209) 474-5022 <br /> Y tl n STAT ZIP CODE 6of Tanks <br /> STOCKTON CA 95207 at Site <br /> P APPL[CJWIT/DlLL[NG NAME APPLICANT CONTACT NAME <br /> P PRECISION INDUSTRIES KEN VANDEGRIFP <br /> [ NAILING A1DRfSS APPLICANT PRONE 1 "44 cwi <br /> A 1041 S. PERSI-aNG AVENUE (209) 462-9911 <br /> r CITY STAT �lP'CODE TYPE of APPLICATION <br /> STOC�N CA 95206 c�4iwr, i+Mr«�«rroN, NYC. <br /> AFACILITY FEE = 1100.90 14(h SITE ADDRESS per YEAR - �� ... _. TOTAL <br /> • <br /> C 1984 138] 1988 1589 <br /> l <br /> E TAIL FEE 6 150,00 144h TANK <br /> F 1 Ya ks _ 1 150.00 1986 1381 1988 _ . ..-1989 _ <br /> A (wltipiy 1-by in for <br /> C <br /> lack year applicable) 1 <br /> [ STATE SUR WGE m 156,00 each TANK (set CA HEALTH 6 SAFETY CODE Sec 25291 for appli(ability) <br /> I 1 Tanks__ a 156.00 1986 198] 1388 1383 <br /> V later iiiiiit aril year) — <br /> C PERNAUT CLOW so or Clowre-in-pla<e) <br /> S CUStIRE FEE • 190,00 each TANK 9o.QQ <br /> 1 Tanks 1�x 430.00 6 <br /> F TWWARY CLOSURE (Only allowed one time for up to two years) <br /> TEMPORARY CLOSURE FEE 680.00 each TANK — i Tanks <br /> P 1M.AN CHECK (lastal 1 at i on or Repair) <br /> L _. .__�E 1 V_E <br /> A <br /> N PIAN CHECK FEE ■ 130,09 each SUM ISSIONIREWOM 15510 E 1 Q 1 <br /> REPAIR ENVIRONMENTAL HEALTH <br /> R TAIN REPAIR FEE = 6110.00 each TANK 6 Trots = $110.00 1 <br /> P <br /> A PIPiNN REPAIR/CLOSURE/REMOVAL (Fees are par hour, minimum one hour to he paid on plan submittal) <br /> T __ _ _ <br /> R UMUHIMIZEI 'RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING 111SPECTION <br /> (Wm 0111(able) (when applicable) (when applicable) <br /> I-IFEE « 630.00lhr FEE * $35.00/hr FEE _ $35.0OIhr 6 <br /> TOTAL 09 6 90.00 <br /> I�flltf it[Ez- <br /> ,.__ . .� NATE RECEIVED PERM[1 1LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK WASH R <br /> iWY <br /> T <br />