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UNDERGROUND STORAGE TANK PROGRAM - FEE VORKSHEET <br /> F FACILITY/SITE NAME FACILITY CONTACT NAME <br /> C 7-11 ALFRED "NICK" PEIVA <br /> I <br /> L STREET ADDRESS SITE PHONE 1 (with Area Code) <br /> l 455 WEST GRANT LINE ROAD, TRACY, CA 95376 (209) 835-7254 <br /> T <br /> Y CITY STATE ZIP CODE t of TANK'S <br /> TRACY CA 95376 at Site THREE (3) <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P PETRO—CTZECK, INC. ROBERT McCULLOW11 <br /> P <br /> L <br /> I NAILING ADDRESS APPLICANT PHONE 1 (with Area lode) <br /> C 271 OPPORTUNITY STREET, SUITE C (916) 927-8155 <br /> A <br /> N CITY STATE ZIP CODE TYPE of APPLICATION <br /> T SACRAMENTO, CA CA 95838 (Closure, Installation, etc.) REMOVAL <br /> A PETRO-CHECK. INC. 1992 —I <br /> C 918-927-8155 <br /> ( 271 OPPORTUNITY ST., SUITE C <br /> 1 SACRAMENTO, CA 95838 i <br /> <br /> <br /> — <br /> TO THE 'n7 Q ^ <br /> F: ORDER OF / Y' <br /> C' � _ <br /> I- _ Yrcj — _-- RS <br /> L <br /> I 81 <br /> T 101 MAIN STREET <br /> Y ' RIO VISTA,CALIFORNIA 94571 <br /> FOR .+A a-�a✓I+C4L T1rr,tn, fi- GGr �'�/ <br /> C " <br /> L <br /> 0 CLOSURE FEE = $90.00 each TANK t Tanks_3__ x $90.00 I$ 270.00 <br /> S — <br /> U <br /> R TEMPORARY CLOSURE (Only allowed one tine for up to two years) NLA <br /> E <br /> TEMPORARY CLOSURE FEE = 180.00 each TANK t Tanks x $30.00 $ <br /> P PLAN CHECK (Installation or Repair) N/A <br /> L <br /> A <br /> N PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION $ <br /> R <br /> E TANK REPAIR FEE _ $110. t Tanks x $110.00 $ <br /> P <br /> A <br /> I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, ainiaua on be paid on plan subdittal) <br /> R <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECT lot, <br /> FEE = 130.00/hr FEE = $35.00/hr FEE = $35.00/hr t <br /> TOTAL DUE $ 270.00 <br /> OFFICE USE ONLY <br /> SUEEPS 1 COMP t LOC CODE DIST CODE I AMOUNT DUE AMOUNT RCVDCHE 1/CASH I RCVD BY DATE RECEIVED PERMIT 1 <br /> :�amanaacswawc�eev�smriRs2e"fft°Z� - -._.d. ;`A^.aT�3'•."�"F�7i:'>'"!'it&.c'^:+.'1C'.^=.': .... ,...:Y.. T "�:..... .'.''s"' u..�:�`._._. . .. ... <br />