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• - - TO 18055462053 –P 10 ^ ' <br /> URDERGROUPSTORAGE TANK PROGRAM FEE 1".-)RKSHEET <br /> FACN TY E FACILI CONTACTNAME <br /> SAFEWAY FUEL CENTER ER NANCY VOVES <br /> FACILITY ADDRESS SITE PHONE M WITH AREA CODE <br /> i <br /> 2808 COUNTRY CLUB <br /> a CITY STATE ZIP CODE #OF TANKS AT SITE <br /> STOCKTON CA 95202 2 <br /> APPLICANT BILLING NAME APPLICANT CONTq—T NAME <br /> j SAFEWAY,, INC. JEFF LEE @ E.D.A. <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE a WITH AREA CODE <br /> 5918 STONERIDGE MALL ROAD 805 549-8658 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE: <br /> PLEASANTON CA 94558 Closure Installation Repair Retrom <br /> i =FACILI995-1999S FACILITY FEE+ 1 TANK 2000 <br /> ER FIRST TANK ($170)X(#tanks)X(#D(yearsapplicable) <br /> 625.00 <br /> SSED $ <br /> TANK SURCHARGE =S8/TANK $ 16.00 <br /> i <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTOR IN A CUPA PROGRAM a 5101 FACILITY $ 10,00 <br /> Ij PERMANENT CLOSURE <br /> 11 Removal 0r Permitted Closure in Place <br /> TANK ID# s CLOSURE FEE_$261/TANK #TANK$X 5261 = <br /> TEMPORARY CLOSURE <br /> Plan Review and Ins 'ons <br /> i <br /> TANK 10#(s): TEMPORARY CLOSURE FEE=$261/FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> .� Plan Check and Construction fns ttions <br /> I <br /> l TANK ID#(3): PLAN CHECK FEE=S696/FACILITY $ 696.00 <br /> REPAIR PLAN CHECK <br /> .1 <br /> i <br /> TANK 10#(s): <br /> :i TANK LINING REPAIR FEE =$2611 TANK #TANKS X$261 = $ <br /> �! TANK RETROFIT REPAIR FEE =$2611 FACILITY $ <br /> ( <br /> PIPING REPAIR FEE _$261 1 FACILITY $ <br /> MISCELLANEOUS <br /> 1 <br /> TRANSFER FEE = $20 $ <br /> i <br /> CONSULTATION FEE = S 871 HOUR $ <br /> } $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE S 871 HOUR <br /> SAMPLING INSPECTION FEE = S 871 HOUR $ <br /> ALL Flea ARE BASED ON THE$37 HOURLY RATE. TIMETHAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. I <br /> i+ OFFICE USE ONLY <br /> SERVICE REQUEST■ FACILITY ID AMOUNT RECEIVEDCHECK N RECEIVED EY DATE RECEIVED <br /> SR <br /> r 'EH 20 002(REVISED 9-2140- <br /> 7'/, <br /> -21-001 3 q7. 50 <br />