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$ cU1R CCUMTY PUBLIC HEALTH S".VICES <br /> NYIRCNMEYTAL HEALTH 0I11ISIC:N <br /> UNIIERGZ 0 STCR.A TANK PRCG m - FE? L1CfIKSHEET <br /> ACILITT SITE NAME FACILITY CONTACT NAME <br /> WESTERN BUILDING MATERIALS T014 WATSON <br /> ISIIE PHONE @ with AREA CCOE <br /> I FACILITY ADDRESS 209} 464-8421 <br /> L 733 S. VAN BUREN ST <br /> I <br /> T CITZr STATE ZIP CSE 3 of TANKS <br /> T ST4CRTON, _ CA 95203 at SITE 1. x 3,0001 gal <br /> A APPLICAM/9[LLING NAME APPLICANT CCHTACT NAME <br /> P <br /> ? WESTERN METER SERVICE, INC. WILLIAM F. MESSICK <br /> L APPLICANT PHONE $ WITH AREA CODE <br /> I %(AILING ACORSSS <br /> 209 948-6124 <br /> A Em <br /> 4 CITY STATE ZIP CezaE TYPE of APPLICATION <br /> STOCKTON, <br /> CA 95205 cLcsla_= rxsrALLATICN, "'-Removed <br /> TOTAL <br /> A I 19116 1(;87 1988 1989 1990 <br /> r <br /> T ANNUAL FACILITY FEE (Prior to Jarxrary 1, 1991) ■ SIC0.00 3 <br /> S <br /> 1 $170/TANK (after Jarx,ary 1, 79917) E=- <br /> 1991) <br /> TANK FEE ■ 550.(10/TANK (prior to Jarwary 1, <br /> : Tacks ; 1986 198T 1928 15291990 1991 11992 1993 11994 11995 1996 <br /> A te+ultipty s ey In ler � 3 <br /> C each year applicable) <br /> I <br /> L STATE SURCHARCE ■ S56.00 each TANK (Out every 5 years) see California H 3 S Cie, Section 25287 <br /> I1991 through 1996 <br /> T 2 Tacks x S56.00 1986 through 1990 <br /> T (enter &-*Lnt and year) 5 <br /> PERMAN€!IT CLCSt:RE (Reamvat or Authorized Closure-in-PLace) TANK I.D. O(s) <br /> L CLOSURE FEE ■ 353.00 per hour (3 hours minimus per TANK} d TANK(s) 1 X $159.00 ■ S159-00 <br /> 0 <br /> S <br /> U TE4PCRARY Ct=;t9 (A one-time permit, for review/irdpecti0m) TANK I.D. 5(s) <br /> R 0 TANK(s) X 5150.00 = S <br /> € TF_xPaWT CLOVRL FEE - 3150.00 eadh TANK <br /> P PLAN CHECK (IrcstalL. Plan Review b Construction Inspections) TANK I.D. 0(s) <br /> L <br /> A5.424.00 minimus S <br /> 9 PLAN CHECK FEE - S53.00 per hour (8 hours minimus per Fac[Lity) <br /> I REPAIR FEE (workptsn review L constnx:1cn inspections) TANK I.D. Ols) <br /> P TAxK REPAIR FEE ■ S53.00 per hour (3 hours minfsxrVTANK) ! TANK(s} X $159.00 ■ S <br /> A <br /> If <br /> R PIPING REPAIR FEE a 553.00 per hour (3 hour minim-n per facility 1159.00) <br /> Y TRA]lSFER FEC ■ 520.00 UNALlTHCRILD RELEASE EVALUATICH ■ $53.00/hr <br /> S ■ S53.00/hr S <br /> C CCNSULTATICN FELE ■ S53.00/hr SAHPLING INSPc_CTiCN FEE <br /> TOTAL DUE S [ S Y <br /> CFFICE USE ONLY <br /> pa.r Tp_y�1•y l��... .��r1Y■li•�--_._.... r.. N'4l.LHj ICC l7 � LAC�X 7I •.`- +1A� Y �aw■antil■q., T�."GVJRiz <br /> ��e�.+�,7� ^� rS1� `� LrA i C KLL�1 <br /> a R�.rS J L:.!'�+<Jie< 3 LC4 i. a Ut3jl Y. e <br /> t <br /> 5 JIS1 <br /> F4 73 ^.32 IZr/ 418/911 ft J, r r' Pace <br /> Y' <br />