Laserfiche WebLink
SAN JUAQUIN LOCAL HEALTH DISTRICT <br />UNDERGROUND STORAGE TANK PRnGRAN • rrr unarsurrT , <br />r <br />rACILITY/SITE NAME <br />FACILITY CONTACT NAME Il?!. <br />C <br />ARCO Facility #6100 <br />J <br />1907 <br />1900 <br />Richard Bokides <br />I. <br />1 <br />STREET ADDRESS <br />SITE PHONE 1 WITH ARCA coot <br />T <br />25775 S. Patterson Pass Road <br />--- <br />(209) 835-7777' <br />Y <br />CITY <br />STATEI <br />IIP CODE <br />I of Tanks <br />SAMPLING IIISPCCTION <br />Tracy <br />CA <br />195376 <br />at Site FNVIRP F TAL HEALTI- <br />A <br />APPLICANT/BILLING NAME <br />1A ES— <br />APPLICANT CONTACT NAME <br />P <br />FEC - 135.00/hr <br />p <br />Barghausen Engineers <br />Frances W. Hedrick <br />L <br />----- <br />1900 <br />I <br />MAILING ADDRESS <br />APPLICANT PHONE I WITH AREA coot <br />IA <br />4612 Roseville Road, Suite #103 <br />(916) 348-3057 <br />N <br />T <br />CITY <br />North Highlands <br />STATE <br />CA <br />I�P'CODE <br />9 660 <br />TYPE of APPLICATION <br />CLowRt, IN�TAlLAT10N, ¢TC. <br />S ?00.00 <br />FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR <br />TOTAL <br />A <br />Tanksz 190.09 <br />C <br />1906 <br />1907 <br />1900 <br />1`�09 <br />I Tanks z 190.00 <br />T <br />A PIPING REPAIR./CLOSURE/REMOVAL (Fees are per hour, ninieum one <br />hour to be paid on plan suboittal) <br />R UNAUTHORIIEO RCLEASE EVALUATION <br />CONSTRUCTION INSPECTION <br />SAMPLING IIISPCCTION <br />(when applicable) <br />S <br />I <br />V <br />rEE = 100.00/hr <br />—� <br />FEC - 135.00/hr <br />E TANK FEE n 150.00 each TANK <br />F I Tanks 4 t 150.00 <br />HOG <br />1997 <br />1900 <br />19013 <br />A (multiply-) by fee for <br />S ?00.00 <br />C each year applicable) <br />L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH 6 SAFETY COOE'Sec 25207 for appli(ability) <br />I Tanks___4 z 156.00 <br />ly, <br />1906 <br />1907 <br />1900 <br />1909 <br />(enter asount and year) <br />224.00 <br />C PCPMANENT CLOSURE (Removal or Closure -in -plate) <br />0 CLOSURE FEE = $10.00 each TANK �1 <br />5 <br />Tanksz 190.09 <br />1 <br />1 <br />P. TEMPORARY CLOSURE.(Only allowed one tiete for up to two years) <br />E <br />TEMPORARY CLOSURE FEE = $00.00 each TANK, <br />I Tanks z 190.00 <br />P PLAN CHECK (Installation or Repair) <br />F TANK REPAIR FCC = 1110.00 each TANKI <br />T <br />Tanks______ z $110.00 <br />1 <br />h <br />11 PLAN CHECK FEE = 130.00 each SUDMISSION/RESUCMISSION <br />; 30.00 <br />REPAIR <br />F TANK REPAIR FCC = 1110.00 each TANKI <br />T <br />Tanks______ z $110.00 <br />1 <br />E— -- --- --- - —_ �_.__... <br />A PIPING REPAIR./CLOSURE/REMOVAL (Fees are per hour, ninieum one <br />hour to be paid on plan suboittal) <br />R UNAUTHORIIEO RCLEASE EVALUATION <br />CONSTRUCTION INSPECTION <br />SAMPLING IIISPCCTION <br />(when applicable) <br />(when applicable) <br />(when applicable) <br />rEE = 100.00/hr <br />—� <br />FEC - 135.00/hr <br />FEE - 105.00/hr <br />1 ^ <br />TOTAL DUE <br />1 �5l.�, o® <br />OFFICE US[ ONLY <br />COM 1 OC CODE DIST CODEJ AMOUNT DUC I AMOUNT RCVO �C�ClECK )/CASH- I REVD DY DATE Purim PERMIT <br />A) <br />