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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> UNDERGROAN,STORAGE TANK PROGRAM - FEE WORKSHEET <br /> F FACILITY/SITE NAME FACILITY CONTACT NAME (209) 462-4581 <br /> A <br /> C Formerly: Lodi Lumber 'project contact: Rich or Marty Thorp <br /> I <br /> L STREET ADDRESS 1025 Industrial Way SITE PHONE 1 (with Area Code) <br /> 1 <br /> T <br /> Y CITY Lodi , STATE IIP CODE 1 0l TANK'S <br /> ' CA 952440 at Site 2 <br /> A APPLICANT/BILLIN6 NAME APPLICANT CONTACT NAME <br /> P <br /> Industrial Way Developers Dave Grilli <br /> L <br /> I MAILING ADDRESSP APPLICANT PHONE 1 (with Area Cade) <br /> C p. Box 1461 209 465-5883 <br /> A5TATE TIP C00E TYPE of APPLICATION Tank Removals <br /> N CITY Stockton, <br /> T CA 95201 (Closure, Installation, etc.) <br /> FACILITY FEE = $100.00 each SITE ADDRESS per YEAR TOTAL <br /> A <br /> C 1986 1987 1988 1989 <br /> T $ <br /> 1 <br /> V <br /> E TANK FEE _ $50.00 each TANK <br /> F 1 Tanksr $50.00 1986 1987 1988 1989 <br /> A (multiply_I_by fee for $ <br /> C each year applicable) <br /> I <br /> L STATE SURCHARGE _ $56.00 each TANK (see CA HEALTH I SAFETY CODE Sec 25287 for applicability) <br /> 1 <br /> T 1 Tanks z 156.00 1986 1987 1988 1989 <br /> Y (enter iiount and year) $ <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L <br /> 0 CLOSURE FEE = 190.00 each TANK 1 Tanks 2___ z $90.00 $ 180.00 <br /> 5 <br /> U <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E1 Tanks x $80.00 $ <br /> TEMPORARY CLOSURE FEE _ $80.00 each TANK <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A $ <br /> N PLAN CHECK FEE = 130.00 each SUBMISSION/RESUBMISSION <br /> REPAIR <br /> R <br /> E TANK REPAIR FEE = 1110.00 each TANK 1 Tanks z 1II0.00 $ <br /> A <br /> I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per how, minimum one hour to be paid on plan submittal) <br /> R <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE _ $30.00/hr FEE _ $35.00/hr FEE _ $35.00/hr $ <br /> TOTAL DUE 1 <br /> OFF►CE USE ONLY <br /> zi <br /> 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT KCVO CHECK 1/1ASH RCVD BY DATE RECEIVED PERMIT 1 <br /> i11b c� ' <br />