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SAN JOAUJIN LUCAL HEALTH UISIRICF <br /> UND UMD STORAGE TANK PROGRAM - FEE WORKSHEET �-- <br /> (.ONIACTIlAAE ' -�---- <br /> FACiLITY1SlTE NAME > <br /> AINC. ' bon <br /> C <br /> NOR-MAC, _ ---- -- ---_ <br /> LPHONE 1 (with Area Code) <br /> ISTRW AWESs 6215 Tam O'Shanter (2,09) 957-9170--� <br /> -- — - - <br /> TITPCHDE 1 of TANK'5 II <br /> Y CITY Stockton. at Site <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> FNOR-MAC, INC. --- Peter_Voskes , Operations Manager <br /> L 0PLICANT PHONE 1 (with Area (ode) <br /> 1 MAILiNG ADDRESS P 0. Box 214097 (91'6) 482_2924 — <br /> (. _ ___ - -.--.- T_- -L.. -_ _ <br /> A STATE IIP COOS TYPE of APPLICATION Re excavation & <br /> TN CITY Sacramento CA 95821 (Closure, Installation, ci=_' resample <br /> TI ----_-�-�.--I- - T-- -- <br /> TOTAL <br /> FACILITY FEE = $100.00 each SITE ADDRESS per YEAR - <br /> A ) f 1986 Li87 1988 1989 ___ <br /> E TANK FEE = 150.00 each TANK _ —- <br /> --- <br /> F 1 Tanks ti S.5p.0J 19Co 1981 <br /> A (Bu 1 by fee for <br /> C each year <br /> STATE SURCHARGE = $56.00 each TANK Lsee CA HEALTH $ SAFETY CODE Sec 45281 for applicability) <br /> T 1386 1981 1388 1983 <br /> T 1 Tanks r 156yea � <br /> Y (enter aiount and year) �4 <br /> IC PERMANENT (LOUR_(Removal or Clesure-tn-Place' <br /> __77- — <br /> L _- -_--- 1 Tanks' r <br /> rTEMF0=RARY <br /> URE FE% _ $90.01 each TANK <br /> -- --- --- -- --- - - <br /> CLOSURE (Only allowed one time for up t.. two years)R.ARY CLOSURE FEE = 180.00 each TANK 1 T+nks z SB0.00 1m _—J <br /> -------------- <br /> i <br /> P PLAN CHECK (installation or Repair, -- <br /> Ai <br /> 1 <br /> N PLAN CHECK FEE = $30.00 each SUBMISSION/RESUBMISSION 1--- -- ----- <br /> REPAIR -- <br /> R - - --- 1 - $110,00 <br /> E TANK REPAIR FEE $110.00 each TANK Tanks- <br /> _�, -- <br /> p ---- <br /> A -- I <br /> I PIPING REPAIR/CLOSURE'REMOVAL (Fees are Per hnur, minimum one hour t+ be Pa(d on plan submitta4i ; -- — <br /> R - SAMPLING <br /> UNAUTHORIIED RELEASE EVALUATION CONSTRU:.T10N INSPECTION <br /> (ehen applicable) (INSPECTION - --- — --j <br /> FEE = 130.00/hr FEF 1 <br /> = f35.00ht TEE = $35.00/hr <br /> f 70.00 <br /> -�---- <br /> -- e TOTAL DUE 1- <br /> OFFICE USE ONLY <br /> SWEEPS i COMP 1 LOC CODE DIST CODE AMOUNT DUEtL7 <br /> UNT RCYD CHECK I/CASH RCVD BY DATE RECEIVED IPERMIT 1 <br /> 1a5� r�� � i � �3r 1-P, <br /> n • <br />