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'DEALAUAID STORAGE TANK PROORM Itt <br /> ie_nwwn <br /> S fACIL11Y SITE HARE FACILITY CONIACI NAME <br /> 1 Independent Trucking Company John Welch <br /> I <br /> E FACI111Y ADDRESS SITE PHOIIE 4 with AREA CODE <br /> 1145 W. Charter Way (209)462-6009 <br /> l <br /> A CITY Stockton, STATE S of TANKS <br /> 111 rroe <br /> CA 206 at SITE 1 <br /> P <br /> P APPLICANI/BIILIRO NAE APPLICANT CONTACT NAME <br /> t W.W.. Miles John Welch (209)951-4727 <br /> I <br /> C HAILING ADDRESS - APPLICANT PHONE 4 NIIN AREA CODE <br /> A PO Box' 1228 <br /> N (415)948-6706 <br /> 1 CITYSIAIE RIP rrDE TYPE o1 APPLIGIION Ilea00Va7 <br /> LOS Altos CA 94024 fClowra, Inst all ellen, <br /> TOTAL <br /> 1986 1981 199a 19X9 1990 <br /> ANUTAL FACIIIIT FEE (Prior to Jamary 1, 1991) 1100.00 — — <br /> A { <br /> C - - — — — <br /> I /ACILIIY PENALTY FEES ASSESSED (1( Applicable) %%KK MIN { <br /> 1 <br /> V IANK FEE • {50.00/TANK (Prior to Jam ary 1,1991) {170/TANK (Altar January 1, 1991) <br /> E - <br /> S lanky • 1986 1981 1989 1989 1990 1991 1992 199! 1994 1995 1996 <br /> F Dull!ply O- lee for - - - - - - - _ - - <br /> A each year applicable) <br /> C — — — q// — <br /> 1 IAOK PENALTY FEES ASSESSED %%N% KA%K ,Oa 7%4 Y 3 3 IJ 1 <br /> l — <br /> 1 STATE SURCHARGE • tl6.00 each TANK (Due every S years) See California N A S Code, Section 25287 <br /> 1 <br /> 1 e lanky R 656.00 1996 throuTih 1990 1991 through 1996 <br /> (Enter amount and year) <br /> (a { I <br /> C PEAIUNENI CLOSURE (Removal or Author lied Closure-In-Place) TANK I.D. S(s) ' <br /> L pj <br /> 0 CLOSURE IEE • 174.00/hour (7 hours minlaAm/IANK) E IANK(s) 1 R 1214.00 1234.00 <br /> 5 /��J <br /> U TEMPORARY ClO5U1E'(Plan Review C Inspections) [AUK I.D. e(s) <br /> R1 <br /> E IEHPORART [lOSURE FEE {79.00/hour IS hours wlnlauNFA[II IIT) • 6274.00 wlnlnm { / <br /> P INSIAILAIION PLAN CHECK (Plan Review S Construction Inspections) TANK I.O. R(I) <br /> L <br /> A / <br /> N PIAN CHECK FEE • N9.00/flour (9 hours minleaMfAC7l11YI • t624.00 wlnl•are IT <br /> R REPAIR FEE (Vorkplan Review S Construction Inspections) TANK I.D. IF(a) <br /> F <br /> P IAIIK LINING REPAIR FEE • {78.00/hour (S hours wlnlnm/IANK) a PARK(s) % 6214.00 f <br /> A <br /> 1 TANK REIROIII REPAIR FEE 178.00/hair 47 hours win./FACILITT) • 4254.00 minlwm t <br /> R <br /> PIPING REPAIR FEE • 179.00/her 0 hours wlnlnm/FACILITY) • 9234.00 mini" 1 <br /> 11 TRANSFER IEE • 120.00 UNAUTHORIZED RELEASE EVALUAIIOH a 17a.00/hr t <br /> I — — <br /> S — — <br /> C CONSULIAIION FEE • 11111.00/hr SANPLING INSPECTION IEE • 179.00/hr 1 <br /> TOTAL DUE <br /> FOR Office USE ONLY <br /> """s1iEEAa"rA" do t€ir7`�a^Pd6 'yrll"L'fl,� A1rrl�nr�rrinJd»tYfk't1C'ilUrow—r-rk'rk1n�6TreaM sauffe"aei41V�v—sa"+' <br /> LT <br /> MA <br /> »r»•»»wi»wena».w»»•»»n::.»•»» Mae <br /> R• .»».»»»r»»•...•»•.•»»•..•»•.•»•»•X id.N»•r w•»H pM�MaM aweM MnW MllalnM A•n MMeIIM MIbYM we• ewYMM�Y Ww MNaNMMMn McAN MYM MMWWMAM MaM MMM MMANIIMM <br /> EN 27 012 (REVISED 1-1-931 Pao* 11 <br />