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SAN JOAQUIN CO Y PUBLIC HEALTH SERVICES-ENVIRONMr"TAL HEALTH DIVISION <br /> IJNDERGRdblI D STORAGE TANK PROGRAM t..E WORKSHEET <br /> FACILITY NAME FACILITY CONTACT NAME <br /> James King Trust Property Jim W. Love, Trustee <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 541 E. Harding Way I N/A <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> Stockton, CA CA 95203 1 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> James King Trust Jim W. Love, Trustee <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 4545 Georgetown P1 . , Bldg D k209 951-5001 <br /> CITY STATE ZIP CODE XCIRCLE WORK TO BE DONE: <br /> — —Stockton T__ ___— CA 95207 Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> 1996- 199 1999 2000 2001 <br /> $500 FEE INCLUDES FACILITY FEE+ 1 TANK ($170)X(#tanks)X(#,f <br /> years applicable) <br /> $125 PER TANK AFTER FIRST TANK $ <br /> $ <br /> TANK PENALTY ASSESSED <br /> TANK SURCHARGE=$8/TANK <br /> $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY INA CUPA PROGRAM=S10/FACILITY 10.00 <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> $ <br /> TANK ID#(s): 1 CLOSURE FEE=3261/TANK #TANKS X$261 = 261,001 <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID#(a): TEMPORARY CLOSURE FEE=$261 /FACILITY <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> $ <br /> TANK ID#(s); PLAN CHECK FEE_$6961 FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID# s): <br /> TANK LINING REPAIR FEE =$2611 TANK #TANKS X$261 = <br /> TANK RETROFIT REPAIR FEE =$261 /FACILITY <br /> PIPING REPAIR FEE _$261 /FACILITY <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $20 <br /> $ <br /> CONSULTATION FEE = S 87/HOUR <br /> UNAUTHORIZED RELEASE EVALUATION FEE = 5 87/HOUR <br /> SAMPLING INSPECTION FEE _ $87/HOUR <br /> ALL FEES ARE BASED ON THE$87 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> OFFICE USE ONLY <br /> SERVICE REQUEST SFACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED <br /> SR <br />