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SAN AOUIN LOCAL HEALTH D RIOT <br /> RGROUND STORAGE TANK PROGRAM - FEE WORKSH <br /> A FACILITY/SITE NAME FACILITY CONTACT NAME <br /> I Valley Auto Repair Tim Ahearn <br /> STREET ADDRESS 4055 N. Wilson Way SITE PHONE I (with Area Code) <br /> T (209) 462-1808 <br /> Y CITY Stockton STATE ZIP CODE I of TANKIS <br /> CA at Site 2 <br /> APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P Re-Manufacturing Stan Moore <br /> L <br /> I MAILING ADDRESS <br /> C P. 0. Box 8098 APPLICANT PHONE I (with Area Code) <br /> A <br /> N CITY <br /> T Stockton, STATE ZIP CODE TYPE of APPLICATION Tank Removals <br /> 2 8 (Closure, Installation, etcJ <br /> A FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR TOTAL <br /> C 1986 1987 1988 1989 <br /> T _ <br /> V /DO " /00 /00 ' 1 / 00- 1'tD0 " <br /> E TANK FEE = $50.00 each TANK <br /> Fi Tanks eZ v $50.00 1986 1987 1988 1989 <br /> A (multipTq-1-by fee for _ <br /> each year applicable) hx) D /0 /'00 f <br /> L <br /> STATE SURCHARGE = 156.00 each TANK (see CA HEALTH k SAFETY CODE Sec 25287 for applicability) _ <br /> T 1 Tanks_ r 156.00 1986 1987 1988 1983 <br /> Y (enter amount and year) <br /> rFERMAMENT CLOSURE (Removal or Closure-in-place) <br /> L <br /> RE FEE = $10.00 each TANK 1 Tanks 2 y 190.00 180.00 <br /> 8U <br /> RRARY CLOSURE (Onl) allowed one time for up to two years) <br /> E <br /> RARY CLOSURE FEE = 180.00 each TANK 1 Tanks a 180.00 f <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> M PLAN CHECK FEE = $30.00 each SUBMISSION/RESUBMISSION $ <br /> REPAIR <br /> R _ <br /> P TANK REPAIR FEE _ $110.00 each TANK 1 Tanks 1 $110.00 1 <br /> A -- <br /> 1 PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimus one hour to be paid on plan submittal) <br /> R <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE _ $30.00/hrl FEE = 135.00/hr FEE = $35.00/hr $ <br /> .� TOTAL DUE <br /> OFFICE USE ONLY 0 ait— 3 <br /> SWEEPS I COMP I HLOCCODEDIST CODE AMOUNT DUE AMOUNT RCVD CHECK IICASH RCVD BY DATE RECEIVED PERMIT t <br /> d5lyU, Liv3 a 3 J 3S'u� / 5 ,r , a' �'9 <br /> ., b <br />