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SAN JOAQUIN LOCAL HEALTH DISTRICT _ <br /> _ UNDERGROUND STORAGE TAM( PROGRAM - FEE YORKSHEET <br /> FACILITY/5111 NAME FACILITY CONTACT NAME <br /> t <br /> Union Pacific Railroad Jim Gray NOV19G:i <br /> L STREET ADDRESS <br /> SITE PHONE 1 WITH ARK* COOK � <br /> T 833 E. 8th (209)942-5265 , U SPCI f.aC. <br /> Y CTrY STAT ZIP CODE 1 of Tanks A P <br /> Stockton <br /> CA 95206 at Site 2 <br /> I A APPLICANT/BILLIN6 NAME <br /> P <br /> r�'" € r 'M j APPLICANT CONTACT NAME <br /> P USPCI, Inc. 5° R , <br /> L Richard Ditmars <br /> I MAILING ADDRESS cr r APPLICANT PHONE <br /> iV�V1[_ WITH ARIA COOK <br /> tEy:Boulder <br /> 5665 Flatiron ParkayNTAL IqI-^ (303)938-5567 <br /> ""' � STAT ZIP'CODE TYPE of APPLICATION <br /> CO 80301 C="O"g, r"KTALLATra'. VTC. Closure <br /> I <br /> FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR A <br /> C -- _ TOTAL <br /> 1986 1981 1988 1989 <br /> T <br /> 1 <br /> V t <br /> E TANK FEE = 150.00 each TANK <br /> F t Tanks x 150.001987 1988 — <br /> A Oultipiy-1'bY fee for 1989 <br /> C each year applicable) <br /> I 1 <br /> IL STATE SURCHARGE = 156.00 each TANK (see CA HEALTH i SAFETY CODE Sec 25187 for applicability) <br /> 1 Tanks x $56.00 1986 1981 1988 <br /> Y (enter asst and )ear) 1989 <br /> — 1 <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L <br /> 0 CLOSURE FEE = 190.00 each TANK <br /> 5 1 Tanks 2 x 130.00 1180.00 <br /> U <br /> P TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E <br /> TEMPORARY CLOSURE FEE = 180,00 each TANK <br /> I tanksr 190.00 $ <br /> IP PLAN CHECK (Installation or Repair) <br /> L - <br /> A <br /> IU PLAN CHECK FEE = 130,00 each SUBMISSION/RESUCMISSION <br /> � _ 1 <br /> R�REPAIR <br /> TANK REPAIR FEE ° 1110.00 each TANK <br /> E — _ 1 tanks_ _ s 6110,00 1 <br /> A PIPING REPAIR/CLOSURE/REMOVAL (fees are per hour, minimum one hour to be paid on plan submittal)IR UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING IIISPECTION <br /> (when applicable) (when applicable) (when applicable) <br /> FEE = 130.00/hrL FEE = 135.00/hr FEE = 135.00/hr <br /> OFFICE USE ONLY TOTAL DUE $180.00 <br /> SUEEPS 1 COMP I LOC CODE DIST rr, <br /> E AMOUNT DUE AMOUNT RCVD CHECK 1/,ASH CVD BY DATE RECEIVED PERMIT I <br /> E'il 1.1 VJ( �GY TL�Y .0:•- YrS }w�iLL4'194 Ml.i'.d'.`.MUI+I•.i�{'".Y !� <br />