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SAN JOAQUIN LOCAL HEALTH DISTRICT y <br /> -RBROUNA STORAGE TANK PROGRAM - FEE NORKSHEE <br /> F FACILITY/SITE NAME FACILITY CONTACT NAME <br /> C Panella Trucking Martin Thorpe (209) 462-4581 <br /> 1 <br /> L STREET ADDRESS 2150 E. Fremont SITE PHONE 1 (with Area Code) <br /> I <br /> T <br /> Y CITY Stockton STATE LIP CODE 1 of TANK'S <br /> CA at Site 4 <br /> F APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P Panella Truckarig Art <br /> L <br /> I MAILIN6 ADDRESS 5000 E. Fremont APPLICANT PHONE i (with Area Code) <br /> C <br /> A 209 -943-5000 <br /> T CITY STATE LIP CODE TYPE of APPLICATION Tank <br /> Stockton, CA (Closure, Installation, etc.) Removal <br /> A <br /> FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR TOTAL <br /> C 1986 1987 1988 1989 <br /> T <br /> 1 $ <br /> V <br /> E TANK FEE = $50.00 each TANK <br /> F 1 Tanks ' <br /> x 1150,00 1986 1987 1988 1909 <br /> A (multiply I by fee for <br /> Ieach year applicable) 1 <br /> STATE SURCHARGE _ $56.00 each TANK (see CA HEALTH I SAFETY CODE Sec 25287 for applicability) <br /> T 1 Tanks x 156.00 1986 1 1987 1988 1989 <br /> Y (enter iiouit and year <br /> f <br /> L PERMANENT CLOSURE (Removal or Closure-in-place) <br /> S CLOSURE FEE _ $90.00 each TANK 1 Tanks__]__ x $90.00 $ 90.00 <br /> U <br /> E TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> TEMPORARY CLOSURE FEE = 180.00 each TANK 1 Tanks x $80.00 $ <br /> P PLAN CHECK (Installation or Repair) P A Y <br /> L <br /> A <br /> N PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION APR <br /> R REPAIR <br /> HEALTH <br /> P TANK REPAIR FEE = 11110.00 each TANK 1 Tanks_ _ x 1110.00 PEWIT/SER CES <br /> A <br /> RI PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE _ $30.00/hr FEE = 13S.001hr FEE = 135.00/hr f <br /> TOTAL DUE $ <br /> OFFICE USE ONLY <br /> 6kNiEPS / COMP 1 LOC CODEGIST CODE AND(NIT DUE AMOUNT RCVD CHECK WASH RCVD BY DATE RECEIVED PERMIT 1 <br /> DI lLta, { qo go — �o3ag v/Z �t/19��9 <br /> a - <br />