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SAN JOAQUIN CC Y PUBLIC HEALTH SERVICES-ENVIRONIV -AL HEALTH DIVISION <br /> UNDERGRO,,,AD STORAGE TANK PROGRAM F WORKSHEET <br /> FACILITY NAME FACILITY CONTACT NAME <br /> The Stockton Record Jim Frankel <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 530 E. Market St 209 943-8550 <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> Stockton, CA 195202 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> The Record Jim Frankel <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> P.O. Box 900 ( 209)943-8550 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE: <br /> Stockton, CA 95201 J X Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> 1996- 1999 2000 1 2001 <br /> $500 FEE INCLUDES FACILITY FEE+ 1 TANK ($170)X(#tanks)X(#of years applicable) <br /> $125 PER TANK AFTER FIRST TANK $ <br /> TANK PENALTY ASSESSED <br /> $ <br /> TANK SURCHARGE=S8/TANK <br /> $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY INA CUPA PROGRAM=S10/FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place) <br /> TANK ID#(s): CLOSURE FEE=5261 /TANK #TANKS X S261 = $261 .00 <br /> TEMPORARY CLOSURE <br /> (Plan Review and Inspections) <br /> $ <br /> TANK ID#(s): TEMPORARY CLOSURE FEE=$261 /FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> $ <br /> TANK ID#(s): PLAN CHECK FEE_$696/FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID# s): $ <br /> TANK LINING REPAIR FEE =$2611 TANK #TANKS X$261 = <br /> $ <br /> TANK RETROFIT REPAIR FEE =$261 /FACILITY $ <br /> PIPING REPAIR FEE _$261 /FACILITY <br /> MISCELLANEOUS <br /> $ <br /> TRANSFER FEE = S20 $ <br /> CONSULTATION FEE _ $87/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = S 87/HOUR $ <br /> SAMPLING INSPECTION FEE = S 87/HOUR <br /> ALL FEES ARE BASED ON THE$87 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED <br /> SR <br />