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SAN JOAQUIN LOCAL HEALTH DI RICT <br /> 9NDERGRDUND STORAGE TANK PR06RAN FEE WORKSHEET <br /> IF FACILITY/SITE NAME FACILITY CONTACT NAME Mike Fowler <br /> 'A California Water Service Company <br /> C <br /> L STREET ADDRESS corner Plymouth St. & River Dr. SITE PHONE 1 wITN AREA COD[ <br /> 464-8311 <br /> Y CITY STATE IIP CODE 1 of Tanks <br /> Stockton, CA_ 95204 at Site----.,-— 1 <br /> _ ._...._-_...__..._ ----._. <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P California Water Service Company Mike Fowler <br /> P <br /> L..._.-..._.__..__._.._..-____.._--_...-__._.._.-.___._...._.-...._..,._-__..._.•__.. MITM AREA CODE <br /> 1 MAILING ADDRESS APPLICANT PHON 1 <br /> C 1602 E. LaFayette Street, 209) 464-8311 <br /> A --- -- - — — ..._..— -----_, ... 1--- ---- <br /> T CITY Stockton, STAT jIP CODE TYPE of APPLICATION Tank <br /> L`A 96206 CLOOwR[. INSTALLATION. [TC. <br /> �_ Bemnva.L-- <br /> FACILITY FEE = $100.00 each SITE ADDRESS per YEAR TOTAL <br /> A ..._,___. _.._.._...._.,,_.__. — _ -- ---------- <br /> T �_1986 �-1987 j`—1988— l --1989—~_---_--•-- s—_--- --_ <br /> V ---- — - — <br /> E TANK FEE = 150.00 each TANK <br /> .---...._....-...................._.__.._._._.._.._ .—...........-.. ..... __.._. . <br /> _ __ f <br /> F 1 Tanks x 150.00 1986 1987 1988 1989 <br /> A (multipfy-i-by fee for — — — <br /> C each year-applicable) `�---�— <br /> I —. <br /> L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH 6 SAFETY CODE Sec 25287 for applicability) <br /> T 1 Tanks x 156.00 1986 1987 1988 t989 <br /> Y (enter 6i6iit and year) <br /> C PERMANENT CLOSURE (Removal or Closure-in-plate) <br /> L — ---- <br /> O CLOSURE FEE = $90.00 each TANK 1 Tanks__ x $90.00 $ 90.00 <br /> S <br /> U..._.----..... --•--- — — --_ <br /> R. TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E -- -- — -- -- — -----—____... _ <br /> TEMPORARY CLOSURE FEE _ $80.00 each TANK 1 Tanks x $80.00 1 <br /> JAPLAN CHEK (Installation or Repair)----PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION $ <br /> REPAIR <br /> R TANK REPAIR FEE = $110.00 each TANKt Tanks x $110.00 $ <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (when applicable) (when applicable) (when applicable) <br /> FEE = 130.00/hr FEE _ $35.001hr FEE _ $35.00lhr f <br /> TOTAL DUE f <br /> OFFICE USE ONLY <br /> u <br /> SWEEPS 1 COMP t LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK 1/CASH RCVD BY DATE RECEIVED PERMIT / <br /> l.iJ <br />