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5:24PM;S8Crhmknro 7MC ;016 9252ala 7- �J y <br /> 5 ZN J DAIM COUNTY PURITC HEAm SERVICES-ENWRONMENTALTM m3tvTMON <br /> UNDEMWOUND STORAGE TANK PROGRAM FERORKSHEET <br /> FACILITY NAME FACILTiY CONTACT NAME <br /> 7--Eleven #14117 Satinder&Bl1it sal <br /> FACILTY ADDRESS SITE PHONE#WITH AREA CODE <br /> 2725 Country Club Lane 209.463-1259 <br /> CITY SFATE ZIP CODE #OFTAMCS @ SITE <br /> Stockton California 95201 3 <br /> APPLIWIT BILLING NAME (WG`1i06gb) AFPLICANTCONT ACTNAME <br /> Sacramento Equipment Nil! tenance Comeany,Inc. Linda Steis[er <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE 9 WITH AREA CODE <br /> 2533 Connie Drive 915.925-2716 <br /> CITY STATE 2IP CIRCLE WORK TO VE UONE. <br /> Sacramento CA 95615 Closure In�IfalJo;7 a ai Retrofkt <br /> ACTIVE FACT= <br /> 500 FEE INCLUDES FACLI Y FEE+I TANK 1997-1499 200 2000 2002 <br /> 125 PER TANK AFTER FIRST TANK ($170)Y{, tang)x( of year$applicable) <br /> TANK PENALTY A55FSSLI) <br /> TANK SURCHARGE-$1Q/TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALRFALjy ON INVE ORY IN A CJPA PROGRAM©$17.50/FACCLTrY <br /> PERMANENTCLOSUPtE <br /> (Remaval of P urrdded Closure In Place) <br /> TANK Ip 4(S), CLOSURE FEE_$257/TANK t TANKS x$267 $ <br /> TEMPORARY CLOSURE <br /> (Plan Rcvic< and Inspections) <br /> TANK ID n(5): TEMPORARY CLOSURE FIE-02671 FACILITY S <br /> d.NSTALLATTON PLAN CHECK <br /> (Plan Check and Camstrurvon lnspedlms) <br /> TANK LU T(s): PLAN CHECK FEE=$712/FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK 1b a(s)-- <br /> TANK LINING REPAIR Fr—r_$267/TANK TANKS x$267 w $ <br /> TANK RETROFIT REPAIR FFF $467 f FAaLnY $ <br /> PIPING REPAIR F�E_$267/FACILi7Y $ 267.UO <br /> �IIscElu,reEous <br /> TWWSFER FEE _$?c <br /> CONSULTATION FEE =$89/HOUR $ <br /> UNAVMOR=RELZASC EVALUATION FEE _ 69/HOUR � <br /> SAMPLING INSPECTION FEE -$fl9/HOUR $ <br /> ALL FEE ARE BASED ON THE$89 HOURLY RATE TIME THAT EXCEEDS FEES PAM WILL BE BTLLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SMVICE RE-QUEST= FACILITY IO AMOUNT RECESVEp CHECK i; VATE RECEIVED <br /> SR <br /> EH 23 032(Revlspi 31I5/az <br /> V:1 munLy t San Ioaquln\err\NnTi5`permit;1 spial-fee worksheet <br /> 18B-H 600000 d OVA-1 EM ZVE HOZ 5014E 01 BS1o9 3113ed HTM-Woad W ea EO-OI-qad <br />