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bMIV JOuU11`1 � • •� •�- <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE YORKSHEET Irk I�I��I <br /> FACILITY CONTACT NAME P. <br /> F FACILITY/SITE NAME `E3 i IQi <br /> CManteca 'frailer Bob Davis <br /> I SITE PHONE t (with Area Code) <br /> L STREET ADDRESS _ <br /> 1 1990 ast_YQaeM1tf1_&2U=— <br /> PATE IIP CODEI of TANK'S <br /> Y CITY CA 95336 at Site One 1 <br /> Manteca <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P Petro—Check, Inc. Forrest Jackson <br /> P <br /> L APPLICANT PHONE 1 (with Area Code) <br /> I MAILING ADDRESS _ <br /> A 271 opportunity t <br /> N CITY STA1E IIPASCODERaA_ TYPE of APPLICATION <br /> C71 (Closure, Installation etc. o_.., �+ J <br /> Sacramento <br /> 1 _ I <br /> A FI PETRO -CHECK. INC. 2092 <br /> —I <br /> C916-927-8155 <br /> T 271 OPPORTUNITY ST.. SUITE C <br /> ( 80-654 <br /> V SACRAMENTO, CA 85838 / �yQ 121i <br /> E If �L <br /> FI ORDER <br /> OF P THE $ 1,5W <br /> PAY - <br /> A (1 JJJe r <br /> L L A R S <br /> L ST <br /> I 8' B"Im ®r RIOT VISTA <br /> T 1 ' 101 MAIN STREET <br /> Y le RIO VISTA EAUFORNIA 84571 / <br /> FOR,��trt <br /> CPE 1I■00209211, 1: 121106S1101:0011 0713321" <br /> 0 CLWUKt rtt = $710.00 each ANK 1 anks1x $10.00 _I$ 90.00 <br /> S <br /> U <br /> R TEMPORARY CLOSURE (Only allowed one tine for up to two years) <br /> E 1 Tanks x SSO.00 f <br /> TEMPORARY CLOSURE FEE = 130.00 each TANK ___ <br /> P PLAN CHECK (Installation or Repair) N/A —I <br /> L <br /> A S <br /> N PLAN CHECK FEE = $30.00 each SUBMISSION/RESUBMISSION <br /> REPAIR N/A <br /> E TANK REPAIR FEE _ $110.00 each TANK 1 Tanksx $110.00 $ <br /> P <br /> A <br /> I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, siniaus one hour to be paid on plan subaittal) <br /> R <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE = 130.00/hr FEE = S35.00lhr FEE = $3 .00/hr f I <br /> TOTAL DUE $ 90,00 <br /> OFFICE OSE ONLY au> <br /> FSVEEPSCOMP N LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK I/CASH RCVD BY DATE RECEIVED_ PERMIT 1 <br />