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I <br />Im.NVIKi.)1VE.42hN IAL 1"1LA_E -IH & EYtiK iM6Y I1. <br />1868E Hazelton Ave.. Stockton,. CA 95205ARM <br />Teles (209) 468-3420 Fax: (209) 468-34331 Web. 1W. Lcehd.roan <br />-FACf-UTYNAME <br />ID # VVII: <br />FACILITY CONTACT <br />i <br />2010 <br />11 <br />2092 <br />2013 <br />2014 <br />$550 FEE INCLUDES FACILITY FEE + i TANK <br />$ <br />PIPING REPAIR FEE = $390 J F 6ILITY use for poft, under-diecL <br />$ <br />SAMPLING INSP TI FEE = $ 130/ HOUR <br />i1i?41*j <br />!' s : lCONTRACTORICC# <br />"' `•'ff <br /># +', TANKS <br />Wiwi <br />APPLICANT BILLING NAME <br />ID # VVII: <br />APPLICANT CONTACT NAME <br />i <br />2010 <br />11 <br />2092 <br />2013 <br />2014 <br />$550 FEE INCLUDES FACILITY FEE + i TANK <br />$ <br />PIPING REPAIR FEE = $390 J F 6ILITY use for poft, under-diecL <br />$ <br />SAMPLING INSP TI FEE = $ 130/ HOUR <br />i1i?41*j <br />!' s : lCONTRACTORICC# <br />AC'nVE FACILITY <br />ID # VVII: <br />9L(LSURE FEE $390 1 TANK <br />2009 <br />2010 <br />11 <br />2092 <br />2013 <br />2014 <br />$550 FEE INCLUDES FACILITY FEE + i TANK <br />$ <br />PIPING REPAIR FEE = $390 J F 6ILITY use for poft, under-diecL <br />$ <br />SAMPLING INSP TI FEE = $ 130/ HOUR <br />$130 PER TANK AFTER FIRST TANK <br />TANK PENALTY ASSESSED <br />TANK SURCHARGE = $15 1 TANK <br />$ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENT Y IN A CUPA PROGRAM =$35.00/ FACILITY <br />m <br />CLOSUREPERMANENT <br />(Removal i ei .; R.'" <br />ID # VVII: <br />9L(LSURE FEE $390 1 TANK <br />TAWS X $390 <br />TEMPORARYTANK <br />+e <br />.! I <br />TEMPORARY <br />INSTALLATION PLAN CHECK <br />Pian Check and Construction I Boras <br />TANK ID a# (s) : <br />PLAN CHECK FEE = $1040 J FACILITY <br />REPAIR'P CHECK <br />TANK ID# (s) : <br />$ <br />TRANSFER FEE = $ 2 <br />TANK RETROFIT REPAIR FEE = $39D J FACILITY (use for monitoring equipment, cold starts, EVR upgrades, <br />$ <br />I spill ets, smps, misc) <br />$ <br />PIPING REPAIR FEE = $390 J F 6ILITY use for poft, under-diecL <br />MISCELLANEOUS <br />` <br />$ <br />TRANSFER FEE = $ 2 <br />$ <br />CONSULTATION FEE _ $130/ HOUR <br />$ <br />UNAUTHORIZED RE SE EVALUATION FEE =,$1301 HO <br />$ <br />SAMPLING INSP TI FEE = $ 130/ HOUR <br />FEES ARE <br />T <br />IN in=;Vl4V r"UKP-T KxIC_ 'RIM= InAf CA4CCu. rCCe?rxlU iY1L1. 6C d1LLCU 9V xrrL. ftWl. <br />9T DUE <br />