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N 1 CU STOCI',T01 ,-A ; 4-19-90 2:40F11 \ CCI 346btl`d33iR e <br /> THT .EQUIP . CO TE J Apr " 9 , 90 14 32 No .003 P .U2/02 <br /> BAN JOAQUIN LOCAL HEALTH DISTRICT <br /> UNDER6900NO STORAGE TANK PROGRAM - FEE NORKSHEET <br /> A fACIIITYISIfE.NAME /._.......__.__....-.__..,_._...._.____.____._._____... FACILITY CONTACT NAME <br /> I —5.51K�_.I <br /> I <br /> l STREET AID RE,BS <br /> SITE PHONE 1 WITH AneA coal <br /> Y CITY p STALL IIP CODE 1 of Tanks <br /> at Site_ __— — -- — <br /> A <br /> APPLICANIISILL106 NAME APPLICANT COHACT NAME <br /> I M ILING ADDRok APPLICANT PHONE 1 WITH AAeN joie <br /> -"r =Li 6(! <br /> N CI1 1� 11P C <br /> STT ODE TYPE of APPLICATION <br /> T a c�owAa, r„arsuerroH=eYe1(�� <br /> FACILIIY TEE ■ 1100,00 each SITE ADDRESS per YEAR TOTAL <br /> `L�.�r <br /> E TANK FEE c $50.00 each TANK <br /> F 1 Tanks -1 150.00 1986 1981, 1988 1989 <br /> A leultipl1 r'by lee for <br /> f tach year applicpblel �� u — d - - I. - 1 -0 I <br /> L STATE SURCHARGE • {56.00 each TANK (see CA HEALTH 6 SAFETY CODE Se( 15281 lot applicability) <br /> T 1 Tanks j, 1 156.00 198) 1987 1388 (983 <br /> Y (enter iaouAt and year) <br /> C PERMANENT CLOSURE (ResoeAl or Closure-in•place) . <br /> L <br /> 0 CLOSURE FEE a 190.00 each TANK 1 Tanks___. s f90.OD 1 Q <br /> U _. <br /> P TEMPORARY CLOSURE (Only allowed one list for up to two years) <br /> IEMFORARY CLOSURE TEE 1 $80.00 each TANK 1 Tanks s (90.00 1 <br /> r. <br /> P PLAq CHECK (insiaiiallon or Repair) Meck- <br /> � <br /> 11 PLAN CHECK FEE .»170.00 each Amount 1 <br /> REPAIR PERM T <br /> R TANK REPAIR FEE a 1110.00 each TANK 1 tanks-;_- 1 1110.00 t <br /> E <br /> A PIPING REPAIRICLOSUREIREMOVAL (lees are per hourr H nisus one hour to be paid on plan subsitkal)—Y 4� <br /> R UNAUIHOR11(6 RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLIN IIISPECTION <br /> (when applicable) (when applicable) (when a li(W el <br /> TEE {70,00/hr FEE 175.001hr FEE 135.00'Ar { <br /> . �. _ti_._ _._ _ <br /> TOTAL DUE 1 <br /> offFCr TSF Olty <br /> _ '. I�^'81i0Vri9 <br /> SWEEPS 1 COMP 1 LOC CODE DISI <br /> COD[ AMWI11 DUE AMOUNT RF,VD -CK 'I/CASH kCVD DY DATE P(CEIVED PERMIT <br />