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SAOJOAQU I N LOCAL HEALTH IRSTR I GT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE 11ORKSHEET <br /> _ FIFACILITY/SITE NAMEn __ _ .� ' __,...__.._.._____� FACILITY CONTACT NAME <br /> C Sullivan & Mann Lumber Co . <br /> I _ Mike Mann <br /> L STREET ADDRESS SITE PHONE # +�'TM ARLA'CODm <br /> 116177 So . McKinley __ 209-858-4737 <br /> T� - <br /> YCITY STATE IIP CODE # of Tanks <br /> Lathrop CA 95330 _ 1 <br /> —_- a t Sit e <br /> A APPLICANT/BILLING NAME �- APPLICANT CONTACT NAME --� <br /> P <br /> P Oil Equipment Service Keith A . Tania <br /> L.._ <br /> 1 MAILING ADDRESS <br /> _ APPLICANT PHONE # wrrN AREA cont <br /> 1, PO Box 950 <br /> A- --�- .., �.��.__..,� 209-754- 1808 <br /> N CITY .._ .-_._. __ .�_ ----..__ <br /> T San Andreas STATE IIP CODE TYPE of APPLICATION <br /> ___ � - CA 952.49_ CLUSURE, INSTALLATION, ETC. Removal <br /> FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR TOTAL <br /> A _.-_.____ __..... ___,� <br /> C _198b� ---_1987..._ ..__-•1988-__. .,.__.1589....__ <br /> T <br /> E TANK FEE = $50.00 each TANK <br /> ....._......... <br /> F # Tanks _ x t50.04 1986-� 1987 � �_. 1988 ---^-�1989 <br /> A (:ultipIy {-by fee for --- <br /> each year applicable) <br /> L STATE SURCHARGE = 156.00 each TANK^(see CA HEALTH ! SAFETY CODE Sec 25281 for applicability) <br /> T 1 Tanks x $56,00 1986 1987 1988 1985 <br /> Y (enter iiount and year) <br /> C PERMANENT CLOSURE�(Removal�or Closure-in-place) ~^-�� � <br /> L <br /> 0 CLOSURE FEE = 190.00 each TANK # Tanks _ x..$30_04 0 1 1 5 0 . OC <br /> U <br /> _1 0 <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) - <br /> TEMPORARY CLOSURE FEE ^ $80.00 each TANK _ T# Tanks _ _ x $80,00 <br /> P PLAN CHECK (Installation or Repair) <br /> )I PLAN CHECK FEE = $30.00 each SUBMISSION/RESUBMISSION <br /> REPAIR -` ---- <br /> RTANK—REPAIR = $1$0.00 each TANK <br /> # Tanks _ __ x 1110.00 <br /> A PIPING REPAIR./CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) ,,✓ <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (when applicable) (when applicable) When applicable) <br /> FEE = 130.00Il�r FEE _ $35.001hr ~FEE =-$35.00lhr <br /> TOTAL DUE 1 15 0 . 0 0 <br /> pIsm?lFFIC�fryI`I181�Sf O�IRI�I�pr��`'m <br /> �Jfi'�lll�"1QAlI S���IfIH�!If��64lll�,�l i 14t"ItlIG%IkI�USJudIW Itldluill' 4iSl�fl�"III�I'JI aIiMYIIUIYI��IIIINI n VIIIKIWISliIG4Nlr�I�YY i N" �V�uII INII��IIYf iIUMI�.I' iIIJI�I Wlillllllli ! BWlI1V 1 gIIYA PSY iW7l4 map <br /> DIST CODE AMOUNT DUE AMOUNT RCVD <br /> . .. �E�JIlCASH RCVD BY PATE RECEIVED PERMIT 1 <br /> W EPS 1 COMP # LOC CODE <br /> z y9 �vcui6 <br /> 07- . f U _..... o y_ - <br /> �' " ' " lI�II�J!�IU�IIli �9 I�I� �V)V1R "' �II��I! /(�o 7 <br /> oil ' " "� � �UII �IIVfIIIIGI� IIVl91 U>�iG118RVfVGt� <br />