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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> WOUND STORAGE TANK PROGRAM • FEE WORKSHE <br /> F FACILITY/SITE NAME FACILITY CONTACT NAME <br /> A <br /> C NOR-MAC, INC. Don <br /> I <br /> L STREET ADDRESS 6215 Tam O'Shanter SITE PHONE t (with Area Cade] <br /> L (209) 957-9170 <br /> T <br /> Y CITY Sockton, �T4TE LIP CODE atoSiteNK'S 1 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P NOR-MAC, INC. Peter Voskes , Operations Manager <br /> P <br /> L <br /> 1 MAILING ADD$SS APPLICANT PHONE 1 (with Area Code) <br /> 0. Box 214097 <br /> C 916 482-2924 <br /> A STATE LIP CODE TYPE of APPLICATION Tank <br /> N CITY <br /> T Sacramento, CA 95821 (Closure, Installation, etc.) Removal <br /> FACILITY FEE = $100.00 each SITE ADDRESS per YEAR TOTAL <br /> C 1986 1987 1988 1989 p <br /> 1 CEI V <br /> E TANK FEE = 550.00 each TANK JUN <br /> F 1 Tanksr $50.00 1986 1987 1988 19 <br /> A (eultipU-1-by fee for <br /> C each year applicable) P p NTAL <br /> I <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH 1 SAFETY CODE Sec 25287 for applicability CES <br /> 1 <br /> T t Tanks s $56.00 1986 1987 1988 1989 <br /> Y (enter iiaaat and year) <br /> 1 <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L <br /> 0 CLOSURE FEE = 190.00 each TANK 1 Tanks a $90.00 $ 90.00 <br /> S <br /> U <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E TEMPORARY CLOSURE FEE _ $80.00 each TANK 1 Tanks a $80.00 t <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> N PLAN CHECK FEE = $30.00 each SUBMISSION/RESUBMISSION 5 <br /> R REPAIR <br /> E TANK REPAIR FEE = $110.00 each TANK t Tanksc $110.00 $ <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 /> UNAUTHORILED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE • f30.00/hr FEE _ $35.00/hr FEE = 135.00/hr S <br /> TOTAL DUE 1 <br /> OFFICE USE ONLY <br /> SWEEPS t COMP t LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK CASH RCVD BY DATE RECEIVED PERMIT t <br /> /2 4 0 *:�o - /035S <br /> a 0 0 <br />