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SAN 30A IN LOCAL HEALTH DISTR I <br /> UNDER6ROUNU STORAGE TANK PROGRAM - FEE WORKSHEET <br /> if FACILITY/SITE NAME FACILITY CONTACT NAME <br /> GRAHAM ROYALTIES LTD. <br /> I_ .-._._.__... __- _..BEAT. AYLE)�___. <br /> L STREET ADDRESS SITE PHONE 1 wlrH AREA coot <br /> 1 9571 S. ROBERTS ROAD (209)941-8711 <br /> YCIT ST�TAE I P D II of Tanks <br /> TOCKTON 5 �} <br /> a t Site � <br /> - .-- ---.....--___-.._._.......... _..� <br /> ...-. --._-...._......___------.___ <br /> _.._....... ._._._..^ <br /> -- .—.._.—_...._..,.. ....,..�_ <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P WARREN �. GOMES EXCAVATING, INC. WARREN E. GOMES <br /> L __._........ <br /> I MAILING ADDRESS APPLICANT PHONE 1 wlrH AREA cant <br /> (707)374-2881 <br /> N i'ITY STATE 2�p CODE TYPE of APPLICATION <br /> T HIO VISTA CAr94S]1 cLOGURE. IHITALLATIOH. ETC. CLOSURE <br /> FACILITY FEE ; $100.00 each SITE ADDRESS per YEAR TOTAL <br /> .._..--.-.- <br /> T 1986 1987 1969 1989 <br /> I t ' <br /> E TANK FEE = $50.00 each TANK <br /> F I Tanksx 550.00 1966 1987 1988 19813 <br /> A (Multipfy_1_by fee for Ei <br /> C each year applicable) i <br /> L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH I, SAFETY CODE Sec 25287 for applicability) �\ <br /> T 1 Tanks x $56.00 1986 1987 1989 1989 <br /> Y (enter aeoant and year) -- ------- -- --- ----- <br /> $ <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) �! T <br /> L <br /> 0 CLOSURE FEE = $10.00 each TANK �1 Tanks1x $90.00 1 90.00 <br /> U -- <br /> R TEMPORARY CLOSURE (Only alloyed one time for up to two years) <br /> E <br /> TEMPORARY CLOSURE FEE = $80.00 each TANK I Tanks x 190.00 $ <br /> i <br /> P PLAN CHECK (Installation or Repair) <br /> L -- <br /> A <br /> N PLAN CHECK FEE 130.00 each SUBMISSIONAESUEMISSION $ <br /> REPAIR <br /> P. TANK REPAIR FEE _ $110.00 each TANK I Tanks_ x 1110.00 $ <br /> E -- <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour,. minimum one hour to be paid on,plan submittal) T <br /> R UNAUTHORIZED RELEASE EVALUATION � CONSTRUCTION INSPECTION SAMPLING 11ISPECTION <br /> (when applicable) twhen applicable) (when applicable) <br /> FEEa.- 13 -- It..r FEE.. ..._..__r—_.--•_-.__ _ ._�._.____...._.—..__._... ---- — .,............._..____.__ <br /> ...._._A_.__..._ 135.00lhr FEE = $35.40/hr $ ' <br /> TOTAL DUE $ <br /> OFFICE USE ONLY t7 �S <br /> D�P10!Q!G.G . � 1 GQ�IR.I.017rIGE I! M01"WG 1F.1�G 10n.,GGail.�i'�# IE�,��g1�WIi.. 11 01=111. ,O a MENAR '.am�Q���li`Ggum uffl wz' a� <br /> f SWEEPS I COMP I LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK I/CASH Rf,VD BY BATE RECEIVED PERMIT I <br /> _.. .. . ........... <br /> .._.... <br /> .. ......_...._ ........_._. ..._.....- ------- <br /> 5" <br /> -----? '"Im.Giil�i���QG !�RGI�G!IQGQi��I1G•'GlI�iIQ�!Q�!GGQ�,��;GlI��.GQGQGi"�'�llQ1a�IGl�lf�i� m�9GQIf�Q�� �11 ' BGG@.. , QGGQQ�1QII'�Q ���!�� <br />