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SAN 1 T,IUIN . LULAL HEAL,'1'H UISTWCT <br /> END3ROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> �fIFAl CILIIY/S1 TE NAME — — — —--- FACILITY CONTACT NAME — — — <br /> Puregro Company Oreo <br /> I"°TREET ADDRESS SITE PHONE I (with Area Code) <br /> 1!1 1904 W. Charter Way (209) 466-2041 — —� <br /> IY: I TSI iF IP CODE 1 of TANK'S <br /> Stockton, CA at Site [ _� <br /> �A' IAPPL(CAN1,r8:LLIW; NAME APPLICANT CONTACT NAME <br /> same__ <br /> �11MAILIN6 ADDRESS APPLICANT PHONE 1 (with Area COJPI <br /> j» iTs STATEITIP COD£ TYPE. e1 APPLICATION Tank Removal <br /> — --1_�Qloswe, Installation, etc.) <br /> I �FACJLITti Fa_E $0-).00 e.i.h SITE ADDRESS per YEAR — — — TOTAL <br /> IIT <br /> II 13W �1988�—. 1989 — T s ------ —� <br /> r J} <br /> �ITANK TEE _ $Sa,00 each TANK <br /> �l P Tanks x $50.00 1986 1387 1988 1383 T — <br /> AI nattrpTyxh ! by fee fa' -- — -- f <br /> (; r„ year ADO lrcatle � <br /> �LISTATE SURCHAHL ; $56.00 each TANK Isea-tA HEALTH t 3AFEIY CODE Sec 25287 (or applicagilltya Itif Tanks^_ _ x 156.00 — 1306 1987 I'm 1989 <br /> Y�Center aaoznt and year` — <br /> �:IM PMANENT CLOSURE tFeaoval or iloive in nlrr ) —� <br /> ^. r'05UP FEE z $90.0 ea ) TANK —I f Tanks 2_ x f90 00 S 180.00 <br /> I°1EMPORARY CLOSURE (nnl �I owed (,ne trap f;?r uP—to two years) — — — —i—� <br /> '` <br /> IMFORARY CLOSURE F££ = f70.0each TANK I Ta _ x $80.00 1 <br /> L <br /> ' RI4N CHECK (�nslallatron or Repar ' —. - <br /> j_1E°LAN CHECK FFF $30.00 each SUBMIS�WNAESUeMISSION �f <br /> FAN: REPAIR TEE *1110,00 each TAN --1 t Tanks 11j0.00 1 —� <br /> !,°)PING PEPAIR/CL0dRElPEMCVAL (Fees are per hour, ain;oue one hour to he pard on plan <br /> submittal) --^ <br /> fT1;UNAUTHORIZED RELEASE EVALUATION 1ANSTRI10ION SAMPLING ' <br /> i"r applicable) IyIN—SPECTION INSPECTION <br /> i $10.00/hr ffE f35,001hr -- FEE = f75.001hr <br /> TOTAL DUE f <br /> OFFICE USI DAIY <br /> ry <br /> q COMP f LDC CODEIDISr tOOF 1 AMOUNT DUE AMDUNI RCV CHECK ASH RCVD BY DATE RECEIVED PERMIT I <br /> NAF, � 32 s��" /gid /o,j `>g �f 2 �o <br />