Laserfiche WebLink
SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> IM <br /> FACILITY/SITE NAME FACILITY CONTA NAME <br /> � Valley Auto Repair Tim Ahearn <br /> I <br /> STREET ADDRESS 4055 N. Wilson Way SITE PHONE t (with Area Code) <br /> T (209) 462-1808 <br /> Y CITY Stockton STATE ZIP CODE s of TANK'S <br /> CA at Site 2 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> F Re-Manufacturing Stan Moore <br /> L <br /> I MAILING ADDRESS P. 0. Box 8098 APPLICANT PHONE 1 (with Area Code) <br /> C <br /> A <br /> N CITY Stockton, STATE 11P CODE TYPE of APPLICATION Tank Removals <br /> T C 95208 (Closure, Installation, etc.) <br /> A FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR TOTAL <br /> C 1986 1987 1988 1989 <br /> T <br /> I $ U U <br /> V _ <br /> E TANK FEE 550.00 each TANK <br /> F i Tanks ?_/_ 1 $50.00 1986 1987 1988 1989 <br /> A (multipry f by fee for <br /> C each year applicable) f <br /> 1 /00 <br /> L STATE SURCHARGE : $56.00 each TANK (see CA HEALTH 6 SAFETY CODE Sec 15187 for applicability) <br /> 1 <br /> T 1 Tanks r $56.00 1986 1987 1988 1989 <br /> Y (enter ii65t and year) <br /> f <br /> C PERMANENT CLOSURE (Remoyal or Closure-in-pla(e) <br /> L <br /> 0 CLOSURE FEE _ $90.00 each TANK <br /> G t Tanks 2 1 190.00 f 180.00 <br /> U <br /> R TEMPORARY CLOSURE (Onl) allowed one time for up to two years) <br /> E <br /> TEMPORARY CLOSURE FEE _ $80.00 each TANK 1 Tanks z (80.00 f <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> N PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION f <br /> REPAIR <br /> R <br /> E TANK REPAIR FEE _ $110.00 each TANK 1 Tanks 1 $110.00 f <br /> P <br /> A <br /> 1 PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> R <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> IEE _ {30.00/hr FEE 135.00/hr FEE = $35,00lhr f <br /> TOTAL DUE s 3 <br /> OFFICE USE ONLY <br /> ZEPMSCOMP t LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK UCASH RCVO BY DATE RECEIVED PERMIT i <br /> i/ b <br />