Laserfiche WebLink
'- SAN JOAQUIN LOCAL HEALTH DISTRICT �)� <br /> UNDERGROUND STORAGE TANK PROGRAM_ FEE WORKSHEET_ <br /> FACILITY CONTACT NAME <br /> IF FACILITY/SITE NAMEIN Qyfi <br /> C <br /> I - SITE PHONE 1 WIT" A""" coot <br /> L STREET ADDRESS (2 09) 463-8636 <br /> T1817 SO. SNO AVE <br /> Y CITY STAT ZIP CODE $ of Tanks 2 <br /> STOCKTON A 95206 at Sxte <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P FLOYD $ARNES - -- Fi OBD $ARNES <br /> L APPLICANT PHONE 1 "'T" AREA came <br /> 1 MAILING ADDRESS (209) 951-7283 <br /> C 1817 SO SNO AVE <br /> TAI <br /> t52CITY SZIP CODE TYPE of APPLICATION <br /> T STOCKTO:v -_ 9520_6 CLOSURE, INSTALLATION, <br /> LTC. <br /> FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR TOTAL <br /> � <br /> 1986 1987 1988 _ 1989 1990 - <br /> T <br /> V 100.0 100.00 100.00 100.00 100.00 $ 500.00 <br /> E TANK FEE _ $50.00 each TANK <br /> F 1 Tanks x 150.00 1986 _ 1987 1988 1989 1990 <br /> A (multipTy-1-by fee for <br /> C each year applicable) 100.00 100.00 100.00 100.00 100.00 $ 500.00 <br /> I <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH k SAFETY CODE Sec 25287 for applicability) <br /> I <br /> T t Tanks x 156.00 1986 1987 1988 1989 <br /> Y (enter iiouit and year - <br /> 112 112.00 <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L <br /> 0 CLOSURE FEE _ $90.00 each TANK $ Tanks x 19 <br /> S 0.00 <br /> U- <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) - <br /> E <br /> TEMPORARY CLOSURE FEE _ $80.00 each TANK ---rt tanksx WAD <br /> L PLAN CHECK (Installation or Repair) --�- - Fye/Rei/0Ogri,,, <br /> A <br /> N 44 <br /> REPAIR PLAN CHECK FEE _ %30.00 each SUBMISSION/RESUDMISSIOH r,� 1 <br /> REPAIR-- <br /> - --------- ----- <br /> P. TANK REPAIR FEE = 1110.00 each TANK 1 Tanks x (110.00 f <br /> E --- <br /> P -- - - - - --- --- - - - <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (when applicable) (when applicable) (when applicable) <br /> FEE _ $30.00/hrl FEE _ $35.00/hr[: FEE = $35.00/hr $ �- <br /> PAYMENT TOTAL DUE $ 1112 .00 <br /> OFFICE USE FNECEIVED <br /> Wm�WV� W9 �'�i�W W9 �W�JW9WW",I¢W1iIWWGW i�A.' RWVW�WWWW�9IUJ� t!WWF"1�Vi'W�q'i�IGGE3G91WRi!Iaid�IlWll'N�uWIiVIW' WBMNIGIWiIII�W�IWWIWV WWCN9.NI�IWI�C��C�'!WWCWWj <br /> SUEEPS 1 ANCOQ1WQli '!OC CODE DIST CODE AMOUNT ASH DUE AMOUNT RCVD CHECK f/CRCVD BY DATE RECEIVED _PERMIT <br /> -- f3LfG a :. <br /> -- - <br /> 7 SED WWD ImraPHPWIiWIu ) P!G mI'i112U ` v Y 3 3r-cp <br /> 1009 I ? PWICJ.�II P �mIIIWBIP.IIIWI�VW�l6 �IIWIOWGWWWWuRfWWWI��IV. 1uP911IB�I�W�IWWWVV�WMWVW91P..NWW�fVh�Wl�6@ �IPai <br /> �a � 5. r� <br />