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�f1FACIL11Y/SITE NAME � • <br /> • .r _ --- <br /> FACILITY 1—AACT 'AME +--~�- <br /> 1� _--Rainbo Eakin Company <br /> L STREET ADDRESS Fred McPherson <br /> l 508 [dalnut Street <br /> f SITE PHONE II WITH -*EA cane <br /> �.. nut <br /> t Y CCTV (209) 368-0345 <br /> Lodi STATE IIP CODE I of Tanks <br /> —�'— CA 95240 at Site <br /> A APPLICANT/BILLINOne <br /> G, NAME <br /> P <br /> P John Mathes & Associates, Inc. APPLICANT CONTACT NAME <br /> L -"�`�`—�— Hank Bellina <br /> I HAILING ADDRESS <br /> 210 West Sand SankRoad, P_p, Box 330 APPLICANF PHONE I WITH AwtA cant <br /> R QTY (6l8) 281-7173 <br /> r Columbia STAT <br /> _ IIP CODE TrPE of APPLICATION <br /> IL 62236 c�oauwt, INeTA�4AT/aN, tic.. <br /> Closure <br /> FACILITY FEE = $l00,0Q each SITE ADDRESS per YEAR <br /> TOTAL <br /> T 0986 I40J 1908 - <br /> , l 1384 <br /> IE TANK FEE $,0.80 each TAfrK t <br /> ----- _ <br /> FI'I Tanks r 150,00 _ <br /> AJ (multi pN-1-by fee for 0486 [307 1908 <br /> �- each year applicable) 1989 <br /> r � <br /> LSTATE SURCHARGE = 556,00 each TANK (see CA HEALTH Ir SAFETY CODE Sec 25287 for applicability) ; <br /> r I Tanks : x56.00 <br /> r (enter am-uuot and year) 1496 1387 [388 1.309 <br /> C PERMANENT CLOSURE (Penoval or ;la,ure-in-plate) �` <br /> I <br /> D CLOSUP.E FEE = 1 <br /> 90.00 each FAN t�` <br /> ' I Tanks_ 1 s $40.00 $90.00 <br /> E TEMPORARY CLOSURE (Only allowed one list, for up to two years) <br /> E <br /> TEMPORARY CLO,UkE FEE <br /> each TAhr I Tanks <br /> P PLAN CHECK (Installation or Repair) <br /> �A � <br /> Ifl FLAN CHECK FEE = 540,00 each SUGHISSION/RESUDNISSION <br /> r f <br /> I [REPAIR <br /> R,TANK REPAIR FEE = 1110.00 each TANK <br /> EI Tanks _ r SI10.00 # <br /> A PIPING REPAIR/CLQ SUP,E/REMOVAL (fees are per hour <br /> REMOVAL , minimum one hour to be Rai` don plan submittal) <br /> -- <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCT ON INSPECTION <br /> (when applicable) SAMPLING INSPECTION <br /> FEE f30,00/hr <br /> (when applicable) (when applicable) <br /> = _ <br /> FEE = 13J.00/hr FEE _ $35.00/hr --- <br /> `�`- -- $ <br /> OFFICE USE 09tr TOTAL DUE $ 90.00 <br /> SkEEPS I COMP I LDC CODE DIST CODE Af10UNT DUE AMOUNT P,CVD CHECK IICASH RCVD r <br /> (?Aifjll' 8 DATE DECEIVED PEP,tfIT I <br /> 1 <br /> -71 <br /> 1 <br />