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ICES - <br /> TAL <br /> SAM uU1N �ERGR�l S11IORAGENTANKVPROGRAJIENYFEE WRgKSMEEPAITN DIVSIdI <br /> �.. FACILITY CONTACT NAME C/ <br /> ,,,E.NAME Jolui Doucette <br /> ACME Saw and Industrial Su SITE PxoxE N with AREA CODE <br /> ,,cf(frY ADDRESS (20 j48-6735 <br /> 1204 E, Main St. N of TANKS <br /> / SLATE ZIP CODE <br /> Clfy CA 95205 at SITE 2 —_ <br /> A Stocktonz_ APPLICANT CONTACT NAME <br /> P <br /> P APPLICANT/BILLING NAME Same as above same as above — <br /> L Anol ICANf PJIONE N 111111 AREA COOS <br /> 1 <br /> C NAILING ADDRESS -- <br /> A <br /> N STATE ZIP CODE TYPE of APPLICATION <br /> 1 CITY CA 952 (Closure, Instal(ation, etc.) loyal I <br /> TOTAL <br /> 1986 1901 1908 1989 1990 <br /> AMNUAL FACILITY FEE (Prior to Januory 1, 1991) f100.00 — <br /> A f <br /> Dplicable) xxx% xxxx <br /> I FACILITY PENALTY FEES ASSESSED (If Ap <br /> 1991) 1991) <br /> 1 S17O/TANK (After January 1, <br /> V TANK FEE • 150.00/TANK (Prior to Januery 1, <br /> E 1986 1987 Well 1969 1990 1991 1992 1993 1996 1995 1996 <br /> N Tanks — --— f <br /> I ("A tfply !—by fee for <br /> A each year eppllcable) _ _ IT <br /> 1 WANK PENALTY FEES ASSESSED %%%% %%%% <br /> t <br /> I <br /> See Catifornis N 6 S Code, lection 2528 <br /> STATE SURCHARGE • 156.00 each TANK (Due every S years) <br /> T 1991 through 1996 <br /> 1986 through 1990 <br /> T N Tanks—? % 156.00 Z <br /> (Enter smount end year) X <br /> TANK I.D. N(s) <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in•Place) % 3236.00 !468.00 <br /> 0 CLOSURE FEE • 118.00/hour (3 hours minim m/TANK) , <br /> STANK I.D. N(s) �— <br /> U TEMPORARY CLOSURE (Pie , Review A Inspectl ong) % !234.00 • f <br /> R __ <br /> F. TEMPORARY CLOSURE FEE • !78.00/hour (3 hours minlnem/TANK) N IANK(s) <br /> 0 INlIALLaIION PIAN CHECK (Plan 0.evlew R Construction Inspections) TANK I.D. #(a)__�---- <br /> L f <br /> A !624.00 minimum- <br /> 0 PLAN CHECK FEE • !78.00/hour (8 hours minllmm/FACILtTY) <br /> LANK I.D. Nls) <br /> R AEPA10. FEE (Workplan 0.evleu t Construction Inspections) % 11234.00 • IT <br /> E <br /> P TANK LINING REPAIR FEE • 978.00/hour (3 hours minlnsm/IAN%) N iAHK(s <br /> f <br /> A . . !234.00 mini mem <br /> I TANK RETROFIT REPAIR FEE • !78.00/hour l3 hours min./FACILITY)ACILI iT) f <br /> R . !234.00 minimum <br /> PIPING REPAIR TEE • 978.00/hour (3 hours mini mm/FACILITY) <br /> I <br /> N TRANSFER FEE • !20.00 UNAUTHORIZED RELEASE EVALUATION • 178.00/hr <br /> I ! <br /> gf70.00/hr <br /> r. CONSULTATION FEE • 278.00/hr SANPLINO INSPECTION FEE !468.00 <br /> TOTAL DUE <br /> m,11 ^1�u <br /> FOR OTfi CE USE <br /> ONLY mP I:: u�1�nm.vmndm;7rJu:: c:w!m!I} i'fmnm!�'�i!1' OnTua!!nm�6tusu�Iti��1� '! n,uu .11m.!v!nm ! Iumu bn u <br /> RECEIVED BY DATE RECEIVED <br /> lu'Im"i6".!�'.1MINNml ,inllumlil� ;m���ml�j�;li:li,ll':, F"L lim!9119VI l^m: n.mmlmmm�mr tni ASH s EEE. VED B'1 Imo n!DATE n <br /> $1l%EP4 N C PUTER N- .LOC CODE DISI CODE AMOUNT RECEIVED CHECK 1/CASH // j <br /> >' Y( -(1�m!��m!��p 1z� �ry�n���'1lmm�mmm��:rrJUJ1__�Iuu� �I !'' ' ��� t !�i'/! '�n 1311!W N <br /> 16�— ' ` 11 I�! M� 3�G V mIN111tC11u lI R111:!II'C1m�I�!:�;"9N PIW911NIIaN1�mm <br /> 1 !lm�P .Me 6Y�1n����"s��114��1�1! ::1: 1'"m" recme��maW�EWLL <br /> EH 23 032 (REVISED <br />