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IIA6JOAQUIN LOCAL HEALTH *5 CT <br /> UNDERGROUND STORAGE TANK PROGRAM FEE NOR T <br /> F FACILITY/SITE NAME FACILITY CONTACT NAME <br /> A <br /> C Robert Bra ton <br /> T SITE PHONE 1 (with Area Code) <br /> L STREET ADDRESS (209) 838-7388 <br /> I 174�) second St <br /> T STATE ZIP E 1 of TANK'S <br /> Y CITY Escalon, Calif-. 320 at Site 1 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P Brayton and Sons Inc. Robert Brayton <br /> L APPLICANT PHONE 1 (with Area Code) <br /> I MAILING ADDRESS <br /> C8 8— 88 <br /> A Po Boy 9c; <br /> STATE ZIP LODE TYPE of APPLICATION <br /> N CITY (Closure, Installation, etc.) Closure <br /> T 95320 Escalon Calif. <br /> FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR TOTAL <br /> A <br /> C 1986 1987 1988 1989 <br /> T 1 <br /> 1 <br /> V <br /> E TANK FEE = $50.00 each TANK <br /> F t Tanksa $50.00 1986 0117 1988 1989 <br /> A (multipTy_1_by fee for $ <br /> C each year applicable) <br /> 1 <br /> L STATE SURCHARGE _ $56.00 each TANK (see CA HEALTH f SAFETY CODE Sec 25281 for applicability) <br /> 1 <br /> T 1 Tanks_____ x 156.00 138fi 1981 1588 1989 <br /> Y (enter amount and year) $ <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> 0 CLOSURE FEE _ A)each TANK $53.00/ hr./3 hr min. 1 Tanks_/ x 290KOIIcx $ 159.00 $ 159.00 <br /> (t0 <br /> S <br /> U <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E 1 Tanks x (80,00 f <br /> TEMPORARY CLOSURE FEE _ $80.00 each TANK ____ <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A 1 <br /> N PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION <br /> REPAIR <br /> R 1 Tanks x (110.00 S <br /> E TANK REPAIR FEE _ $110.00 each TANK --- <br /> P <br /> A <br /> 1 PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to he paid on plan submittal) <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE _ $30.00/hr FEE _ $35.00/hr FEE _ $35.00/hr f <br /> TOTAL DUE f 15 .00 <br /> OFFICE USF ONLY <br /> ZICOMP t LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK WASH RCVD BY DATE RECEIVED PERMIT t <br />