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_vovct icn 0 , I, _ 1 _qac) <br /> ' <br /> ), <br /> Slice L 1391-1 -kN <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT In 0(-L�ef- 4r10 <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET Mon" <br /> jrjFACII.II*Y"/'5I`rE NAME FACILITY CONTACT NAME <br /> 1h <br /> Sliarl)e Army Depot j(11111 J. <br /> L STREET ADDRESS SITE PHONE I WIT. A..A C..r, <br /> load, Environmental Program office (209) 982-2093 <br /> Y CITY STATE —IIP CODE_ Cat <br /> (0_ _s - <br /> Latllrup CA 95331 Site <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> f. I.--- <br /> 3-, I " 3-E <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE I WITH AREA CODE <br /> I: . q L <br /> A <br /> t. 1,1T STATE IN Josue <br /> P'CODE TYPE of A'PPLICATION ,qL— <br /> CLO8URE, INGTALLATIO' r0 <br /> FACILITY FEE 1100.01 each SITE ADVESS per YEAP <br /> TOTALA .......... <br /> 19811386 1988 1509 <br /> I TAur. FEE = I50.00 each TANK <br /> ..........I..................... .._. .-_._._.......I.._ . ...... <br /> f I Tanks x 1986 988 90 <br /> (mullipli-1-by lee (or <br /> each year applicable) <br /> L STATE SURCHARGE -- 156-00 each TANK (see CA HEALTH Ii SAFETY CODE Sec 25287 for Applicability) <br /> I I Tanks x 156.00 1396 1387 1908 1309 <br /> Y (enter ig_;Znt and year) ....... <br /> ........... ....... ......._.__..._-----•-- ------.... -- -...—-----— -------- S---- ----— <br /> �:rPEP.IfANENC <br /> ------ <br /> f"-IRe"oval of Closure-in-place) <br /> 0 CLOSURE FEE <br /> TANK; I Tanks x 1,110.00 <br /> PliEnPOPARY CLOSURE (Only allowed one time for up to two years) <br /> FEMPORAPY 110111PE FEE S80.0 each TANK 11 I,inl:-, <br /> ........... <br /> P PLAN CIICCK (IfIstallati-M or Repair) <br /> L <br /> A <br /> 11 PLAN CHECK FEE 130.00 each SUBM ISS 1011/EESUCHI Sil 1011 <br /> ........... <br /> PEPAIR <br /> . <br /> ......... ................. <br /> F TANK PEPAIR FEE = 1110.00 each TANK I Tanks <br /> E ------ <br /> A <br /> 7777A PIPING PEPAIP/1-LOSURE/PEHOVAL (Fees are per hour, minieuA one hour to be paid on plan submittal) <br /> I.. UHAUIHOPIIED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMP1,016 INSPf(TION <br /> (when applicable) Ivhen applicable) en applicable) <br /> FEE 131 00/h IEE <br /> ..................---------- <br /> TOTAL DUE <br /> offict usf 011r <br /> RIM, 1;1 ki P.F,U I i 172 Ll N 1111721013 .390,171tR <br /> Sw(fors I COMP I I-Of CODE DIST CODE AHOUHT DUE AMOUNT FCVP 0110! WAS <br /> I"i VATF E,F.I PM I I I <br /> I 77--y7- <br /> r <br /> ........... <br /> A t <br />