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JOAQUIN LOCAL HEALTH#ISTRICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORXSHEET <br /> ....... FACILITY CONTACT NAME <br /> I'F 'FACILITYISII'L NAME <br /> r Pacific Coast Producers , ad Ober <br /> I -I.,--- SITE PHONE I WITH AREA CODE <br /> LkTREET ADDRESS az- <br /> 1 32 Tok!g_Street-____._- <br /> T -jA zJ111 CODE 1tot Tanks <br /> YICITY at �L"L 3 <br /> Lodi, 4 U.—_I_ <br /> A APPLICANTIBILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P SUI)A. Inc. _�4yjje i�auRan <br /> L APPLICANT PHONE I WITH AREA CODE <br /> I MAILING ADDRESS <br /> (916) bl'5-1100 <br /> 918 Kent Street, Suite I L - L' <br /> A ii�7C'TD E TYPE of APPLICATION <br /> STATE N�CITY C LOSURE, INSTALLATION. Etc. Reitioval <br /> 'A 9 <br /> T Elk Grove CA 9-5624 <br /> FACILITY FEE = 1;100.00 each SITE ADDRESS per YEAR TOTAL <br /> A .............. ....... .................. <br /> C. 1987 1988 I989 <br /> T <br /> V <br /> 1E TANK FEE : S50,00 each TANK <br /> ........... <br /> F I ,Tank % 550.00 1986 1907 1988 1989 <br /> A I t i Ir <br /> (mu P Y51-by fee for <br /> C each year applicable) <br /> II I.---.-. <br /> 1�L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH I SAFETY CODE Sec 25287 for applicability) <br /> T I Tanks x 156.00 1986 1987 1988 1989 <br /> 'Y (enter ii65n-t and year) ---- <br /> C PERMANENT CLOSURE (Removal Or Closure-in-place) Removal <br /> L ---------- $ <br /> 0 CLOSURE FEE = $90.00 each TANK I Tanks__B--. x $90-00 270.00 <br /> S <br /> U ------- <br /> PITEMPOPARY CLOSURE (Drily allowed one time for UP to two Years) <br /> E <br /> A.TEMPORARY CLOSURE FEE each TANK I Tanks------ x 180.00 <br /> —---------- <br /> IP PLAN CHECK (Installati�-,n U Rej;diT) <br /> IL --------- <br /> A <br /> N PLAN CHECK FEE = s?0.n0 each SUBMISSION/RESUBMISSION <br /> . ............... <br /> REPAIR <br /> R TANK FEPAIR FEE $110.00 each TANK I Tanks $110.00 <br /> CA PIPING REPAIR/CLOSURE/REMOVAL—(Fees are per hour, minimum one hour to be paid on plan submittal) <br /> IR UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (when applicable) (when applicable) (when applicable) <br /> ......... 1� 4 7 - <br /> FEE ar FEE $35.LOFhjr <br /> FE-C: $30-00/hr <br /> TOTAL DUE <br /> OFFICE USE ONLY <br /> .......... <br /> CODE AMOUNT DUE AMOUNT RCVD CHECK WASH RCVD BY DATE -RECEIVED PEP <br /> ........... <br /> WEEPS <br /> COMP I LOC CODE DIST <br /> N <br /> '11,1� <br /> r1q, 71 <br />