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S4N JOAQUIN LOCAL HEALTI' DISTRICT <br /> r (AGILITY/SITE NAME UNDERGROUND STORAGE TANK PROGRAM - fEE b#KSHCET <br /> A 1 <br /> C Delta National Bank fACILITTC0NTACT'NAME <br /> I <br /> L STREET ADDRESS Roan Dalben <br /> 611 North Main <br /> T SITE PNDM� 1 MIT" ArrA Carr <br /> T CITT (2 09) 526-4986 <br /> Manteca SIA <br /> Ca . 1 of Tanks <br /> A APPLICANT/DILLING NAME al Site ( 1 ) <br /> P Don Lambert & Sons APPLICANT CONTACT NAME <br /> I MAILING ADDRESS Blake Lambert <br /> r P.O. Box 659 <br /> A APPLICANT PHONE 1 MIT" sats cos[ <br /> i CITY g1__R7a a16_ g <br /> Waterford IIP'COOE TYPE <br /> Ca of APPLICATION <br /> Ca . 95386 ea.o.veeg rM•T.u.ATrrs. [Te. <br /> C fACIIITiEC ° 1100,00 each SITE ADOP.ESS per YEAR <br /> Closure <br /> T 1706 1907 TOTAL <br /> 1 1908 1907 <br /> V <br /> E TAN) fU • 150.00 each TANK 1 <br /> r 1Tank' - <br /> A frvllioril'by tee1900 <br /> sISO /or 1986 1787 __"--- <br /> 1' <br /> C nch year applicable) 191 <br /> 1 <br /> STATE SURCHARGE • 156,00 each TAXK (see CA HEALTH I SArETy CODE Sec 25287 for ap <br /> pliubililyl 1 <br /> t1 1 tanks 1 156,00 1906 <br /> y (enter iiount and year) 1701' 1908 1707 <br /> t <br /> C PERMANENT CLOSURE (Pero—vat er Closure-in-pl_-_Act) <br /> t <br /> 0 CLOSURE rFE +190,00 each TANK r— <br /> S 1 Tanks_j 1_1 T (70.00 1 <br /> U 90. 00 <br /> R TEMPORARY CLOSURE (Only alloved one list for up to lvo yard <br /> E _ <br /> TEMPORAPY CLOSUCC IEE • 180.00 each TANK <br /> 1 Tanks _ x EO-00 <br /> f <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> H PLAN CHECK fEE = 00.00 each SUDMISSIOH1RESUenI55IOM <br /> t <br /> REPAIR <br /> P TANK P.EPAIR rcE = IIIA,00 each TANK -——_ <br /> C 1 Tanks 1 1110.00 1 <br /> A PIPING REPAIR/CLOSUPE/PEMOVAL trees art per hour, rinlrus one hour to be pail on plan subr <br /> I <br /> R IINAUIH0RIIEO RELEASE EVALUATION CONSTRUCTION INSpECTIOM <br /> (vhrn applicable) tvhen applicable) SAMPLING 1IISPCCTION <br /> fFE $70,00/hr (vhen applicable) <br /> r[E = 175.00/hr r 1]5.00/hr <br /> t <br /> OrriCr 1ST DI(r TOTAL DUE 1 <br /> SWEEPS 1 COMP 1 LDC CODE DIST CODE AMOUIIT DUE AMOUNT RCyD CHEr,K I/CASH RCVA Dy 087E RECEIVED PERMIT I <br />