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UNDERGROUNI; STORAGE TANK PR06RAM FEE WORKSHEET <br /> F FACIL]TY/SITE NAME <br /> A FACILITY CONTACT NAME <br /> Ci JOHN RAY CO. INC.. <br /> I <br /> L}STREET ADDRESS SITE PHONE t (�ithl Are4 Coae) <br /> I, 2249 Waterloo Rd. <br /> T, (209) 466-3561 <br /> �YlCiT1 Stockton STA1E ?IP CODE t of TAN$'"S <br /> Ca. 95205 Iac Site (3) 2,000 gal eaclh <br /> �AIAPPLIChNTrtILLIN NAME APPLICANT CONTACT NAM <br /> Stocktcxn Contracting Group, Inc. Jerry JOy <br /> 11MAILINe AGDxESE 1000 N. Union St. II APPLICANT PHONE t (wit, Arei Cooe', '. <br /> I <br /> I (209) 462-5082 A { <br /> Stockton STATE TIP CODE ITYPE o1 APPLICATIO1 <br /> j Ca. 95205 (Closure, Installation, etc,) CLOSURE <br /> IFACILITY FEE = SIOC-00 each SITE ADDRESS per YEAr TOTAL <br /> A, <br /> T� 1986 P I9Ei 198E 1989 <br /> £ TANK FEE _ $50.00 each TANK <br /> F # Tanks x $50.00 1986. 1987 1988 1989 <br /> A (emultiply-lt-by fee for <br /> C each year applicable) $ <br /> I <br /> L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH & SAFETY CODE Sec 25287 for applicability) <br /> I , <br /> T # Tanks z $56.00 198b 1 137 1988 1989 <br /> Y (enter iiount and year) <br /> w $ <br /> C PERMANENT CLOSURE (kesoval or Closure-in-place) <br /> L <br /> O CLOSURE FEE = $90.00 each TANK # Tanks 3 x $90.00 ; 270.00 <br /> 5 <br /> R TEMPORARY CLOSURE (Only alloyed one tine for up to two years) <br /> E <br /> TEMPORARY CLOSURE FEE _ $80,00 each TANK' i Tanks x $80,00 $ <br /> EPLANCHECK, <br /> Installation or Repair) <br /> E _ $30,00 each SUBMISSION/RESUBMISSION $ <br /> • i <br /> 7ETANK <br /> AIR <br /> REPAID FEE _ $110,00 each TAMP; I Tanks _ I fIiG,00 �$ <br /> A <br /> 1 PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hoer, ■inipul one hour to be paid on plan subaitta1) <br /> R <br /> UNAUTHORIIEI, RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE = $30.00/hr' FEE _ $35.00/hr FEE _ $35.001hr <br /> TOTAL DUE S <br /> Witt USE AKLY p 9�3 f—� <br /> SWEEPS # <br /> COMP # LOC CODEIDIST CODE AMOUNT DUE AMOUNT RCVD CHECI; 1/CASH RCVC BY DATE RECEIVED PERMIT # <br />