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10/28YI5 03:44PM BZ Service Station Maintenance 916-572-1050 <br />• SAN JOAQUIN COUN'117V qP <br />V"NVIRONMEWTAL 14FAL.'r1i DIaPARTMFNI' <br />1868 E. Flazelton Ave., $Jockton, CA 95205.6232 <br />Telephone: (209) 468-3420 fiva (209) 468-3433 Web: �vwyLj <br />�qy.IV, elitt. <br />P.07 <br />--KP�U�AWT—BRLTING NAME <br />APPI-1115' CONTACT —NAME <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />CITY <br />CIRCLE WO!! ins D <br />........... <br />CONTRACTOR JCC 9 <br />Closure Installation m Re to <br />$500 FEE INCLUDES FACILITY FEE * A TANK (2007.2fjoti) <br />$580 FEE INCLUDES FACILITY FEE 0 ITANK (2009.2ou) <br />$125 PER TANK AFTER FIRS'[ TANK <br />TANK PENALTYASSE;SSE <br />TANK SURCHARGE x; S16 I TANK <br />A <br />11 1 2012 1 201-3 <br />INSTALLATION PLAN CHECK <br />TANK 10 0 (s) PLAN VIECK FEE = $10001 FACILITY <br />WE —PA1VF;1-WVd-WWff <br />TANK —1Q 4 <br />TANK RETRORTREPAIR FEE - $M i FACILITY (use for monitoring equipment, gold stiglis. EVIR upgrades, <br />p_ <br />PIPING REPAIR FEE $375 /FACILITY ((A%,- for piping, vnd4er4wenser containment. eco . ....... ... <br />MISCELLANEOUS <br />TRANSFER FEE z 525 <br />CONSULTATION FEE = $ 125t HOUR <br />UNAUTHOR1250 RELEASE EVALUATION FSE = $ 12.6 / HOUR <br />I SAMPl!NG INSPECTION FEE ry $ 125/ HOUR <br />AIA, FEES ARE 0ASED ON TKE $125 HOURLY RATE. TIME THAT eXCi W-f;WE$PjUD—WC UFTRIZI) FTO WP—jJr.7WtFT*,'--- ��j � , _.'M ^W <br />TOTAL AMOUNT DUE <br />