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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> � UND' OUNO STORAGE TANK PROGRAM FEE WORKSHEET <br /> FIEACILITY/SITE NAME — FACILITY CONTACT NAME <br /> A <br /> C BJJ Coapany, Inc. Nick Kosta <br /> I <br /> L STREET AINNIESS SITE PHONE 1 w"M mm" Comm <br /> T 2431 E. Mariposa Road _ (209) 841-2576 <br /> IRT CAT ?2 it <br /> 1 of Tanks <br /> at Site two <br /> A APPLICANT/IILLIN6 NAME APPLICANT CONTACT NAME <br /> P Precision Industries, Inc. Nick Bokides <br /> L — --— <br /> 1 UILIN6 AIDRESS APPLICANT PHONE 1 Y1N <br /> C1041 R 209 462- 911 <br /> A -- <br /> N CITY STAT IIP CODE TYPE of APPLICATION <br /> T Stockton, CA 95206 cwouoa, 7pIpRp04;89DpppX <br /> FACILITY FEE + $100.00 each SITE ADDRESS per YEARTOTAL <br /> C 1986 1987_ 1988 1989 <br /> T — <br /> 1 1 <br /> V <br /> E TANK FEE _ $50.00 each TANK <br /> F 1 Tats _ 1 $50.00 $986 1987 1988 1969 <br /> A (altlply 1-hy fee for -- <br /> C each year applicable) $ <br /> l <br /> L STATE SURCHARGE _ $56.00 each TANK (see CA HEALTH L SAFETY CODE Sec 25287 for applicability) <br /> I <br /> T 1 Tanks 1 $56.00 1986 1901 1988 1989 <br /> Y later iiount and year) — <br /> C PELVAUT CLOSURE (Removal or Closure-in-place) <br /> L _ <br /> 0 CLOW FEE _ $90.00 each TANK <br /> S 1 Tanks____ 1 $90.00 $ 90.00 <br /> U <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E <br /> TEMPORARY CLOSURE FEE : $80.00 each TANK 1 Tanks z $80.00 $ <br /> P PIAN CHECK (Installation or Repair) <br /> A -- <br /> NPLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION $ <br /> REPAIR <br /> R TANK REPAIR FEE + $110.00 each TANK 1 Tanks 1 {110.00 $ <br /> E <br /> P _ — -- <br /> A PIPIN6 REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> I _ <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (wm applicable) (when applicable) (when applicable) <br /> FEE + $30.00/hr FEE _ $35.00/hr FEE + 135.00/hr $ <br /> TOTAL DUE $ 90.00 <br /> IFFICE NTE IILr <br /> WEEPS 1 COMP 1 LOC CODE 011T CODE AMOUNT DUE AMOUNT RCVD CHECK 1/CASH RCVD BY DATE RECEIVED PERMIT 1 <br /> l JJ�o�y - — - - - <br /> - <br />