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uNUtNONOUNU STURAGE TANK PROGRAM - FEE WORK 1 <br /> F FACILI'Y/SITE NAME FACILITY WTACT NAME <br /> � - � �( t�(�?Vl� � , �1 .iC� 1rn W).rI TTL <br /> L STREET ADDRESS SITE PHONE 1 (with Area Code) <br /> Y CITY v '"S _ 77 I <br /> R-pj1�C R STATE uuP COBE 1 of TANK'S <br /> Gt' Ss31 at Site <br /> A APPLICANT/BILLING NAM <br /> F APPLICANT CONTACT NAME <br /> P 1 t u ( ro �(t�S? . �11IC'T - IrK �jljI TTLE . <br /> I MAILING ADDRESS APPLICANT PHONE 1 (with Area Cade) <br /> A 1 011 J I �0 ago ' lo l <br /> N CITY STATE i COBE TYPE of APPLICATION <br /> T �(� NTS n' ' <br /> 63z � (Closure, Installation, etc.) (/WJ-AiJ?4. <br /> TOTAL <br /> � �YiUr"SrF's SOUTH SAN JOAQUIN DELTA NATIONAL 13ANK <br /> MlAIV1L(;A. GV 9y, ,,, <br /> _ e IRRIGATION DISTRICT CHECKNo. 00207 j <br /> , �. •'-0 MANTFCA, CAI.II'ORNIA <br /> 95336 <br /> 'tit77 <br /> fiME. H111ITiFi1.=:T7 1':.T(':HTY �N!) y(n .I WO I)( DA LA <br /> . Fc;:; iv <br /> / <br /> OA1E CONTROL NO, <br /> A N1pUPJ I <br /> PAY <br /> T'0 THE / <br /> ORDER 71 •.loacµ.lin Hraa:Lt:h <br /> OF 16O1 Ea <br /> t-sFlaze:L'l:'c,n <br /> '. 0. RLix 2O499 <br /> 0.1. <br /> nulhVNVLo 7ioWsiunr <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> N PLAN CHECK FEE = $30.00 each SUBMISSION/RESUBMISSION $ <br /> REPAIR <br /> R <br /> E TANK REPAIR FEE = 1110.00 each TANK <br /> P 1 Tanks a 1110.00 $ <br /> A - - <br /> I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, sinimw 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 = 135.00/hr FEE _ $35.00/hr f <br /> TOTAL DUE S J • c'v <br /> oma USE ONLY <br /> SWEEPS 1 COMP 1 LOC CODE BIST CODE AMOUNT DUE AMOUNT RCVO HECK /CASH RCVD BY DATE RECEIVED PERMIT 1 <br /> 3J4 4 !Sd 20 <br /> 77 <br />