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Work Order: 2254987 • <br /> SAN JOAQVIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 Ems'Main Street Stocklm CA 95202.3029 <br /> Telephone:(209)465-3420 Fox:(209)468-3433 Web.www s'Eov or <br /> FACILITY NAME /'� <br /> .I I / U 1 p FACILITY CONTACT NAME <br /> FACILITYADDRESSAMDDRR.ESS54 a <br /> SITE PHONE i WITH AREA CODE <br /> CITY <br /> -ThC'C <br /> STATE ZIP CODE <br /> i OF TANKS AT SITE <br /> CA <br /> APPUCANT BILLING NAME <br /> �0.-f�., APPLICANT CONTACT NAME I <br /> APPUCANTMNUNG AD I 4l CP'aL UVL;;-['Z_ <br /> / APPLICANT PHONE i NTHAREA CODE <br /> �9 11 �cPe'G/Y� zccc /v.J=l <br /> CITY N Z-AL.� <br /> STATE DPCO E CIRCLE WORK TO BE DONE <br /> p CONTRACTOR ICCs <br /> D4 r,�(,Z{(f Gosure Instillation Da ReUofit <br /> ACTIVE FACILITY <br /> 55M FEE INCLUDES FACILITY FEE.1 TANK(2002-2007) 2002 2003 2004 2005 2006 2007 <br /> $550 FEE INCLUDES FACILITY FEE•1 TANK(2008 8 New <br /> In-UK.as o/8//,07) <br /> 5125 PER TANK AFTER FIRST TANK S <br /> TANK PENALTY ASSESSED $ <br /> TANK SURCHARGE-$151 TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM-524 00/FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal a Permittee GDaura in PUM <br /> TANK ID i a : CLOSURE FEE_$2941 TANK i TANKS%3294• $ <br /> R <br /> TEMPORARY CLOSURE <br /> Plan Review and In f <br /> TANK ID i(a): TEMPORARY CLOSURE FEE-$294/FACILITY <br /> INSTALLATION PLAN CHECK <br /> Ptin CMrA <br /> and Construction I 'ona <br /> TANK IDS(3): $ <br /> PLAN CHECK FEE $7841 FACILITY � <br /> REPAIR PLAN CHECK <br /> TANKIDi s <br /> TANK RETROFIT REPAIR FEE =$294/FACILITY um fm monRan a ui enL s ill ourkels,tank sum s,misc.)$ <br /> PIPING REPAIR FEE •$2941 FACILRV uss fm ulMer4a neercontiinmenL ed. <br /> MISCELLANEOUS <br /> TRANSFER FEE • $20 $ <br /> CONSULTATION FEE • S 981 HOUR $ <br /> UNAUTHORIZEDRELEASE EVALUATION FEE S98/HOUR $ <br /> SAMPLING INSPECTION FEE • S 981 HOUR $ <br /> ALLFEES ARE BASED ON THE f9a XWRLY RATE.TIME MATE%CEEOS FFES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERWCE REOUESTa FACILITY ID AMWNTRECEIVEO CXECKa RECEIVED BY DATE pELEIVED <br /> SR <br /> EX zi wz(REVISED oelal4>f <br /> Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 <br />