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vim <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ` IF"KfiROM0. STOWE TAfin PIOGRAM - FEE NORKSM <br /> F FACILITYISITE NAME FACILITY CONTACT NAME <br /> A pelta Truck Sales Kenneth Smith <br /> C <br /> ~`. L STREET ADDRESS 3437 Newton Road SITE PHONE I (with Area Code) <br /> � I <br /> Y CITY Stockton Sr�tAE IIP CGDE 1 0l TANK'S <br /> 1t Site <br /> A APPLICANTIBILLING NAME APPLICANT CONTACT NAME <br /> P Delta Truck Sales Kenneth Smith <br /> P <br /> I MAILING ADDRESS 3645 Cherokee APPLICANT PHONE I (with Area Code) <br /> C -4161 R - xcav tion <br /> A STATE IIP !OfttPLICATION work plan <br /> N CITY Stockton CA Installation, etc.) <br /> T <br /> FACILITY FEE _ !100.00 each 517E ADDRESS per YEAR TOTAL <br /> C 1986 1987 t988 1989 <br /> T ! <br /> 1 <br /> 4 — <br /> E TANK FEE _ $50.00 each TANK <br /> F I Tanks __ _ s (50.00 1995 1987 19SB 1993 <br /> A (multiply I by fee for $ <br /> Itach year applicable) <br /> STATE SURCHARGE -- 156.00 each TANK (see CA HEALTH I SAFETY CGDE Sec 25287 for ipplicability) <br /> . T I T:nits_____ s lSfi.OD 1986 E987 1986 1984 <br /> Y (enter aPount and year)' f <br /> C PERMANENT EL05UiE (Removal Of Glasure-(a-plsce) <br /> 0 CLOSURE FEE �, 10 <br /> $90.00 11th TANK 1 Tanks _ s ---- f <br /> f S <br /> U <br /> R TEMPORARY CLOSURE (Only allow0d ono time !0r up to two years) <br /> E ?EMPORARY CLOSURE FEE s 1$0.00 taus TANK i Tanks s f80.00 f <br /> i <br /> P PLAN CHECK iinstallation or Repair) <br /> L S <br /> N PLAN CHECK FEE $30,00 ac:h SUINISSIONIRESUIMIS510N f <br /> ' REPAIR:_ <br /> R U10.00 1 Ttnks s !)10.00 $ <br /> P TANK REPAIR FEE <br /> � a�ash TANK _ <br /> ; . . A <br /> ! R PIFINE I:a hIRItLOSUREIRENVAL (Foes are per hour, minimum one h to be paid on plan submittal) <br /> UNAUTHORIIEO RELEAU EVALUATION CONSTRUCTIONre x aova ion SAMPLING <br /> (whin applicable) INSPECTIONworC an consul NSPECTION <br /> FEE a 130.001hr FEE _ $35.00lar 35.00 FEE a $33.001hr 35.00 $ 70.00 <br /> TOTAL DUE $ 70.00 <br /> I OFFICE 11H OILr <br /> SHEEP$ i COM? I LOC CODE DISI CODE AMOUNI DIE AMOUNT RCYD CHECK $!CASH WON DATE RECEIVED PERMIT i <br /> i �o° /1930 3�iI8 <br />