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10/17/2000 09:00 2094583433 FIFTH FLIM PAGE 13 <br /> SAN JOAQUIN CQUNTY PUBLIC HEALTH 5I:7.K1(jCE&F:NVIR0NMr:NTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> FACIL NAME FACILMY CONTACTWAMFE <br /> PACIFIC AVE. ARCO MARK YETKA <br /> AGfLFTY ESS SITE PHONE AMA 0501 <br /> 6425 PACIFIC AVE. <br /> C[TY <br /> STAME ZIP MAW #Of AN"AT Slf I' <br /> sTOCKTON <br /> GA 95202 3 <br /> APPLICANT 09-LING N AAC APPL C Ml;ACT NA <br /> JASON C MARK YEKTA` <br /> PC(CAIYr 14F C�rii ADDAEBS APPUCANT PMORE# AREA CODE <br /> .0. BOX 2228 <br /> _____�21ry STATE I ZIP CODE _-MRCLA WORK TO BE E. <br /> ANVILLE CA 9,5426 <br /> lnsfs>wlllon Repair RsAnpFt <br /> TIME FAC! <br /> 1995— 1999 2000 <br /> $500 FEE INCLUDF_S FACILITY FEE+ 1 TANK (5170)X tanks X v of earsappl,mtge <br /> $125 PER TANK AFTER FIRST TANK <br /> TAW U TY ASSESSED � <br /> TANK SURCHARGE=H I TANK � <br /> STATE SUAC}IARCE FOR FACJLJFIES NOT ALREADY ON INVENTORY IN A CUPA PROORAM $10/FACILRY � <br /> PERIIRj!►AIL'HT CLOSC3R� <br /> I?a or Permitted C*sure In ftce <br /> TANG IDS s : CL URE FEC; 201 1 TANK CCI TANKS X 261 <br /> Y CLQ9IJRI= <br /> Plan Revlew snd Inopedional <br /> TANK ID# !I: $ <br /> f T�+a�r cL13suRE FFA=seas r F=ACILFTY <br /> ENSTALf ATION PLAN CHXCK <br /> par Check wii Owszs!s n cUcns <br /> TANK 10 S(s) PLAN CHECK FEE Se98/FACILITY $ <br /> REPAY;PLAT+CHECK <br /> LANK 1O N E <br /> TANK U NTNG REPAIR FEE ■$2611 TAMC #TANKS X$261 <br /> TANK R>~TROFIT REPAIR FEE a$261 /FACILITY <br /> PTMN{;REPAIR FEE $281 /FACILITY $ <br /> 6AI3C! <br /> TRANSFER FEE S 20 $ <br /> SULTATIDNI FEE n i 87/HOUR S <br /> UNAUTHORtZEO RE $PSE EVALUATION FEE - S 87 I t UFA <br /> 5Aiu PLtNa INSPECTION FEI: r S M/HOUR <br /> A�L FEES go CN Tm m a TMT gXcEEMS PERS PAID WA.L B <br /> ASkOFFICF-USE ONLY <br /> T M 10 AMOUNTREcrarmF C5MCK It R C61VS0■Y DATE R[C[IViD <br /> SR <br /> a�u oss IiiJSlr13E.0�t.aaf <br />