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UNDE"-°OUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> �FIFACILITY/SfTE NAME V IFACILITY COtdTACT E <br /> I: Auto Investments/Chase Chevrolet Bill Channell <br /> � ...__._—....._—.--'-----'-----__...._..._......_.---'--------.-..�..........._....—.. <br /> L STREET ADDRESS SITE PHONE # WITH AREA cane <br /> 1 423 North Madison (209) 838-3507 <br /> T ...------'-_...._..... ------- <br /> y <br /> -----Y CITY SSI TE IIP CODE I of Tanks <br /> Stockton 95361 at Site 3 <br /> .............----__ -_ _..__....__..__-----._._..---___ _ _ _ __ ___--____—• <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P Auto Investments c/o WaterWork Bill Channell <br /> L ......_._....------- <br /> i MAILING ADDRESS APPLICANT PHONE # w1rN AREA caVC <br /> A <br /> 1710 Main Street (209) 838-3507 _ <br /> -' ------'-- --'- --'— --'--------- -- -''--'--'- - -'- <br /> t; CITY - - - rSTATE IIP CflOE - TYPE of APPLICATION Temporary Closure <br /> T Escal on LCA 95320 CLOSURE.APPLICATION <br /> tom. <br /> ET <br /> FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR TOTAL <br /> C 1986 1987 1988 1983 <br /> jE TANK FEE _ $150.00 each TANK <br /> -... --- -.._.... ..__.................._....._.._......_....................- - -_- -_.- _ __._..........._...._._.-...................._...... <br /> .- - <br /> IF R Tanks _ _ x 550.00 1386 1987 1988 1389 <br /> A (multipTy by fee for <br /> I: each year applicable) $ <br /> L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH k SAFETY CODE Sec 25287 for applicability) <br /> T # Tanks x 156.- 1386 1981 1988 1983 <br /> Y (enter imount and year) ---- _ — --- __— <br /> _..-._-----------._ <br /> i <br /> I: PERMANENT CLOSURE (Removal or Closure-in-place) <br /> O CLOSURE FEE _ $10.00 each TANK # Tanks x $90.00 $ <br /> IS TEMPORARY CLOTURE (Only allowed one time for up to two years) <br /> jE--- - --------.— _ _ _ --- ------ <br /> TEMPOPAPY I;LOSUFE FEE _ $80.00 each TANK # Tanks_ _3 x $90.00 S 240.00 <br /> -- <br /> P1PLAN CHECK {Installation or P,epair? <br /> r•, <br /> IN FLAN CHECK FEE $30.00 each SUBMISSION/RESUDMISSION ; <br /> #REPAIR <br /> P TANK REPAIR, FEE _ $110.00 each TANK I Tanks x $110.00 $ <br /> E <br /> A PIPING REPAIR./CLOSUREIAEMOVAL (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 $30.00/hr FEE _ $35.00/hr FEE _ #35.00/hr $ <br /> TOTAL DUE $ 240.00 <br /> OFFICE USE ONLY mr�I pmm <br /> I V; ! .. ;dl � �I I OF IMMI <br /> t SWEEPS # COMP # LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK #/CASH RCVD 8Y DATE RECEIVED PERMIT II <br /> _....._._-_ _...__.. ._. _.__._._.... _._---_------__ ..._...................15..15 ............._..... <br /> ..,..... <br /> ti ' i u 1 C�. �.,,.I I I I G .I a �I lImm . G <br />