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SAM JOAUUiN i-UCAL 'HFAAL.TH DISTRICT <br /> %meiRGROUND 3TORAGE FIANR PROGRAM - FEE NORKSHE6,,04 _ <br /> ACILlTY/SITE NAR_ FkCIL4i CONTACT NAME <br /> j A Cope P'anUfactui-1nc Co. � "tiles Cope <br /> L ~ SITE PHONE I (with Area Code) <br /> L STREET ADDRESS �04C0 N. ):%>r,nefick Road <br /> 1 _ _ _ _ — _ (209) 334-1999 <br /> Y CITY — v — n — STATE EIP CODE A of TANK'S -- <br /> lcampo, 93220 at Site 1 - ---- --� <br /> IA APPLICANT/IALIN6 NAME APPLICANT CONIACI NAME <br /> P same <br /> P <br /> t`MAILING ADDRESS APPLICANT PHONE 1 (with Area Cede( <br /> C1 <br /> NCITI Y — — -- STATE IIP CODE TYPE of APPLICATION Tank Removal 1 <br /> T, (Closure, Installation, etc.) l <br /> FACIL??Y GCE = f)^0.00 each SITE ADDRESS per YEAR TOTAL <br /> A — <br /> --_—_ — —�—1996 1987 1988 1999 <br /> T — -- - — - — <br /> 1 <br /> TANK FEE = $50,00 each TANK <br /> F 1 Tanks x $50.00 — '—ly88 1787 1998 1999 <br /> A (multipTy-I-by fee for i-- -- —­ <br /> C each rear applicable) S <br /> L STATE APCIKAPGC - 556.00 each TANK (see CA HEA1,1F' 6 SAFETY CODE Set 15287 for applicability) <br /> I — — — <br /> T I Tants $56.00 1986 1387 1988 1789 <br /> 'Y (enter 456t and year) <br /> C PERMANENT CLOSURE (Removal or Cloeure-in-place' — —�—V <br /> 0 CLOWFEE - S4n.9 each TANK —�! Tanks_ 1_ x 190.00 —�f 90.00 <br /> — <br /> R TEMPORARY CLOSURE (Only allowed one time fcr up t, two years) — <br /> E <br /> TEMPORARY CLOSURE FEE : $80.00 each TANK ! Tanks x (80.00 f <br /> —._— ----- - --.—__ —_ —..—�_—J — <br /> P PLAN CHECK (Installation or Repairs ----- -- -- <br /> M PLAN CHECK FEE = 5'0.00 each SURMISSIOHIRESURMiS51ON S <br /> RFPAIF �—T------- <br /> R -- - - ----- - --- ---- <br /> P TANK REPAIR FEE = fit0.00 each TANK _— — ! Tanks z f110.00 <br /> A �-- -- --- ---- ----- -----f---- <br /> 1 PIPING REPAIP!CLOf ;RE%RENOVAL (Fees are per hour, mirimum oce hour to be pard on plan submittal( <br /> R -- ---- _ —, _ -- -- <br /> UNAUT;+GRIiED RELEASE EVALUATION 1CON51RUCTION SAMPLING <br /> (when applicable) $INSPECTION INSPECTION <br /> FEE —lFFE = $35. /hr — FEE = 135.00lhr — f <br /> TOTAL DUE f 6?0 <br /> OFFICE USE OAU <br /> SEEPS I CDNP ! LOC CODE DIST CODE AMOUNT DUEAMOUNT RCVD CHECK I/CASH RCVD BY DATE RECEIVED PERMIT I <br /> � 1 9 390 /05ff3 _- <br /> , ,y. <br /> LJ J2 t <br />