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SAN JOAQLIIN LOCgL HEALTI-f DISTRICT <br /> U GROUND STORAGE TANK PROGRAM - FEE RORKSHEE <br /> --- <br /> IFAClllT9/SITE NAME FACILITY C,ONTAC NAME <br /> it ;• ANDY 'S AUTO PARTS WESTERN METER SERVICES, INC. <br /> 1A - - 209 948-6124 _ <br /> 7. <br /> ;STP:.EET ADDRESS 22U SITE PHONE I VITM AREA CODE <br /> 236�TE. MAIN. STREET209 948-6124 <br /> YY21P CODE I of Tanks <br /> STOCKTON CA 95205 l at Site ONE (1 ) <br /> - ......... .. ..........._.. -----JA APPLICANT/81LUNCi HAMS APPLICANT CONTACT NAME <br /> P ANDY'S AUTO PARTS WESTERN METER SERVICES, INC. <br /> F' <br /> L -- - ....._._..._...........................__. <br /> I MAILINry2A08P�SSE. MAIN STREET 2_0_9_.._.._948_-6124 <br /> APPLICANT PHONE 1 W'TN AREA CODE <br /> A - - -- -----------------_............................... ..... ....................._209......__948.-6124 - -- <br /> T CITY STOCKTON STATEI 7IP CODE ...... <br /> TYPE of APPLIr,ATION CLOSURE <br /> ooue E, ,Ne TAIEATION, erc. <br /> .._._....._�.�..._� ..Q..E�..._.._...____..._.......... <br /> ..............—..................__....._...._.._...___..._....-.__..._._.....__..__......______..___.--- <br /> FACILITY FEE = St0O.Ou each SITE ADDRESS per YEAR• i <br /> ,A - — - -------- TOTAL I <br /> C 1386 1301 1300 .(383 .O <br /> r -- I I ... <br /> t _ <br /> £ TANK FEE = f50.U0 each 1AIIK <br /> -- - .. <br /> ......_._.............................._...............-_......-..-........_pLT /�ci!p� A + <br /> F I Tanks _ _ s f50,00 - <br /> A (multiply I by fee for 1186 Ii87 1790E P <br /> __.... -._.-......- .__.. .........................................._..._........_' ,�Qy', <br /> !I <br /> C each year applicable) <br /> I <br /> L STATE SURCHARGE = S56.00 each TANK (see CA HEALTH L SAFETY CODE Sec 25287 for "app Iic bi'kiT n �9 <br /> ------- ---- ------ - <br /> 1 1 Tanks - . a 556.rin Igg6 (9g) 1308 138'3 SO <br /> Y (enter 5 6iliit _... ...........__. <br /> ----- �-----.._...__....... S ! <br /> ----- <br /> -- ._..... <br /> .........._.__.......___-.._..__.... <br /> C PERMANENT• CLOSURE (Renoyal 'or Closure rn pla e) <br /> L --- - <br /> -- - ----� <br /> 0 CLOSURE FEE = f30.00 each h TANK <br /> f <br /> S I I Tanksc $90.00 <br /> -- — -- <br /> U ------- ..... <br /> R TEMPORARY CLOSURE (Ont) alloved one tine for up tr tvo year <br /> TEMPORARY CLOSUf,E FEE - 580.00 each TANK I Tanks s E90.00 f <br /> - - ------- - -- -- _ <br /> P PLAN CHECK Plnstallation or Repair) T <br /> IL = - <br /> A <br /> tl PLAN CHECI:.FEE = (311.00 each SUBMISSION/RESUDMISSION S s , <br /> ---- <br /> REPAIR _........................--------- - -- <br /> P. R, FEE = $110.00 ea h TANI I Tanks : f110.00--- - <br /> .. . .. .... . ..AIR/rLOSURE/P.EMOVAL (Fees are per ho r, minimum one hour to be paid on plan submittal) <br /> - . ---------...._......-- . ------ - <br /> ED P,ELEASE.EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> ieablei (vhen applicable) (vhen applicable)001hr. IFIE ,35 00/hrl FEE _ (35,00/1 S <br /> k <br /> TOTAL DUE S <br /> OFFICE USF OMLy. <br /> MEMO! fl9UU811CB0009UI1ufl91UUUUUUUVIIUI•Ilvllll!UOil!II�IU.911111111UpUUl!IUIIIII!IIIUIIhI IJIVIUIIVUiIUIIIUIUIIdIIIIUUUV9I��IVI!fIUIU!MIiIIN�IUI�UU�UUUUUUVI�66� <br /> $BEEPS 1 COME I LO;. CODE DIST r,ODE AHOUIJT DUE „AMOUIIT PrV 711als,711111m, <br /> CASH F,n;UD BY DATE RECEIVED PERMIT 1 <br /> ._-. yl <br /> 11 7© <br /> o�.��alp�d1U !IIII000UIIP <br /> r t 8� <br />