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01,114 JVxi lJV 11V LVI.HL r1G HL aft UIMIKI11- I <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE&SHEET <br /> F FACILITYRITE NAME FACILITY CONTACT NAME <br /> CRipon Fire Department Gene Vanderplaats <br /> I <br /> L STREET O RESS SITE PHONE I (with Area Code) <br /> I 2 S. Stockton Avenue (209) 599-4209 <br /> r <br /> Y CITY STATE IIP CODE 1 of TANK'S <br /> Ripon, CA 95336 at Site 1 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> r same <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE 1 (with Area Code) <br /> C <br /> A <br /> FOR <br /> T. <br /> RICH-MART 10747 <br /> JIM THORPE, DISTRIBUTOR OF QUALITY PRODUCTS <br /> 368-6175 462-4581 <br /> -- 351 NO. BECKMAN ROAD, P.O. BOX 357 <br /> LODI, CA 95241-0357 �109/1R11 <br /> _ PAYTOTAL TO THE <br /> ORDER OF 'L�Fi�Ci _ —_" , - I $ jD <br /> Civ UNT �n <br /> DOLLARS <br /> Baik�f�'mck>Goa i <br /> ,ODI OFFICE <br /> in W.Walnut 51..Ludt,CA 9520 <br /> gir <br /> O CLOSURE FEE = 130.00 each TANK <br /> 5 t Tanks ] x 130.00 f 90.00 <br /> U <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E <br /> TEMPORARY CLOSURE FEE = $90.00 each TANK 1 Tanks x $80.00 f <br /> P PLAN CHECK (installation or Repair) <br /> l <br /> A <br /> N PLAN CNECK FEE = 130.00 each SUBMISSION/RESUBMISSION f <br /> REPAIR <br /> F <br /> E TANK REPAIR FEE = 1110,00 each TANK 1 Tanks x 1110.00 f <br /> p - <br /> A <br /> I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> R -- <br /> UNAUTHORIIED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE = $30.00/hr FEE = 135.00/hr FEE _ $35.00/hr f <br /> TOTAL DUE I <br /> OFFICE USE ONLY <br /> SNEEPS 1 COMP I LOC CODE DIST 000E AMOUNT DUE AMOUNT RCVDCI C CASH RCVD BY DATE RECEIVED PERMIT 1 <br /> I a <br />