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SO JOAQUIN LOCAL HEALTH DISTRICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE IIORKSHEE�. <br /> F fACILITY/SITE HANE —' ----— — <br /> IA <br /> FACILITY CONTACT NAME <br /> C BILL J. RACKLEY <br /> I DANNY RACKLEY <br /> L STREET ADDRESS SITE PHONE I <br /> 1 3333 S. HIGHWAY 99 WITH AREA coot <br /> T 209-948-8586 <br /> Y CITY STATE ZIP CODE I of Tanks <br /> STOCKTON CA 95205 at Site TWO <br /> A APPLICAHUBILLTNG NAME <br /> F APPLICANT CONTACT NAME <br /> LA <br /> ILL J. RACKLEY DANNY RACKLEY <br /> ING ADDRESS -333 S. HIGHWAY 99 APPLICANT PHONE I "ITS AA%A c00% <br /> 209-948-8586 <br /> — STATETOCKTON CA 912000E TYPE of APPLICATION <br /> 5 c�ueu.c, I %TA��wr1aM, %rc. CLOSURE <br /> FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR <br /> __ TOTAL <br /> C 1906 1901 1908 —1507 1990 <br /> I S <br /> V $100.00 f 100.00 <br /> E TANK FEE = 150.00 each TANK <br /> r I Tanks 2 _ 1 $50,00 — — 1586 (50) <br /> A Iiultipiy-I by lee for 1908 1989 1 990 <br /> C each year applicable) <br /> $100.00 $ 100.00 <br /> L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH V SAFETY CODE Sec 25281 for applicability) <br /> I <br /> T I Tanks a 156,00 1986 — 1907 170$1 1 — <br /> Y tenter iiount and year) __ _— 905 <br /> t <br /> 1' PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L <br /> 0 CLOSURE FEE 190.00 each TANK <br /> S I Tanks 2... x $70.09 1 180.00 <br /> U ------_--_ <br /> P. TEMPORARY CLOSURE (Only allowed one time for up to tvo years) <br /> E — <br /> TEMPORARY CLOSUF,E FEE = 500.00 each TANK <br /> L <br /> I tanksa 10000 $ <br /> CHECK (Installation or Repair)CHECK FEE _ $70.00 each SUOMISSIOII/RESUOMISSIOII - <br /> riAl _ <br /> AIR FEE = 1110.00 each TANK <br /> — I tanks—PAIP./CLOURE/REMOVAL (fees are per hour, minimum one hour to be paid on plan submittal) <br /> ZED RELEASE EVALUATION CONSTRUCTION INSPECTION licable) (vlen applicable) SAMPLING IIISPECTION <br /> (vhen applicable) <br /> .00/Iv --- TEE = 175.00lhr --- <br /> FEE = 175.00/hr 1 <br /> TOTAL DUE 1380.00 <br /> OFFTCI USF ONLY <br /> j <br /> amMA¢r �. E�uSNEEPS I COMPOCCODEODE AMOUIIT DUC AMOUNT , I/rASH Ra Lti --k rv '�96mti o 'm�a�!mco ? mmVml6mIINJ�fII?�1971^lYmUl[m��lERrua,ul6�tmrmnpgat�umnp'Mgr manMnAnn.nnm.n w� gwmx...,, .m... <br />