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UNDERGROUND STORAGE TANK PRO6RAM - FEE WORKSHEET <br /> F fArIi ]TYlS1TE NAME (FACILITY CON NAME <br /> I -JOHN RAY CO. INC_ f ,► _V� <br /> L STREET ADJkESC <br /> 11 7249 Waterloo Rd. SITE PHONE i (vith Area 'Co6e) <br /> Ti 1 (209) 466-3561 <br /> 1Y CITY Stockton ---7. <br /> TATE ZIP CODE It of TANL'ls <br /> Ca. l 95205 la; site (3) 2,000 gal each <br /> A�APP�ICANTicI�LINe NAM: APPLICANT CONTACT NAM= <br /> �' Stocktan Contracting Group, Inc. I Jerry JOy <br /> I� + <br /> Il CMAILINc AD[�1;'E;w, <br /> ICT 1000 N. Chian St. 1 APPLICANT PHONE I (with Arei Cooe <br /> IAS (209) 462-5082 <br /> JT"+CTT+ Stockton =. 9' <br /> TYPE of APPLICATION I <br /> (Closure, Installation, etc.) CLOSURE <br /> I JFACILITY FEE = $10L.00 each SITE ADDRESS per YEAR <br /> 1A TOTAL <br /> T <br /> C 198E 1981 I 198E 1989 a <br /> I <br /> ------------- <br /> V F �s <br /> E TANK. FEE _ $50,00 each TANK <br /> F # Tanks x $50.00 1986 1967 1988 1989 <br /> A (multiply F-by fee for <br /> C each year applicable) I__=� <br /> I s <br /> L STATE SURCHARGE _ $56.00 each TANK (see CA HEALTH I'SAFETY CODE Sec 25287 for applicability) <br /> I . <br /> T # Tanks x $56,00 1986 1§87 1988 1989 <br /> Y (enter amount and year) <br /> $ <br /> UPERAANENT CLOSURE (Removal or Closure-in-place) <br /> E FEE _ $90.00 each TANK # Tanks3 z 5900G S 270.00 <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E <br /> TEMPORARY CLOSURE FEE z $80.00 each TANK' # Tanks x $80.OG <br /> S <br /> P PLAN CHECK (installation or Repair) <br /> L <br /> A <br /> N PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION <br /> $ <br /> 1 <br /> REPAIR <br /> R <br /> E TANK REPAIR FEE _ $110.00 eacf+ TAN(; # Tanks z $110,00 IS <br /> P <br /> A <br /> 11 PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, mintmua one hour to be paid an plan submittal) <br /> F,. <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION SAMPLING I <br /> (when applicable) INSPECTION INSPECTIOV <br /> FEE _ $30.00/hr FEE _ $3`.00/hr FEE = $35.00/hr <br /> i <br /> TOTAL DUE <br /> MICE USE ONLYP` '&-� S 31 a <br /> LSWEEPS # CMP # (LOC CODEDIST CODE AMOUNT DUE AMOUNT RCVD CHECK t/CASH RCVD BY DATE RECEIVED PERMIT # <br /> � ,�-7 d— <br />