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SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVSION 7 IJP /4q <br /> RGROUND STORAGE TANK PROGRAM - FEE WORKSHES <br /> ,,pLITY SITE NAME FACILITY CONTCT NAME <br /> PETER F. PERSIC, <br /> 7 141LTTY ADDRESS SITE PHONE M With AREA CCDE--. - <br /> CITY STATE ZIP CODE # of TANKS <br /> A STOCKTON CA 95202 at SITE Two <br /> P <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> L PROPERTIES IPETER S <br /> I F. <br /> Aic <br /> MAILIPI O.NGBOX E`t>9 ��2 T py E,A124VN AREA CODE <br /> N �r O//// 77 `I/ <br /> T 1`IURTH HOLLYWOOD 5FAA1E 2J,p„Gpp6 TYPE of APPLICATION <br /> 11,, �1011� (Closure, Installation, etc.) <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) 2100.00 <br /> A S <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) %K%% %%XX S <br /> i — <br /> V TANK FEE = $50.00/TANK (Prior to January 1,1991) f170/TANK (After January 1, 1991) - <br /> # tanks • "'"' -- <br /> C,M .�a���a�a�� 112 14 <br /> P,—A/M Emmy BANK D ARTER ON <br /> HEADQUARTERS <br /> STOCKTON. CA 85202 <br /> P.O.BOX 1257 90-103-1211 a 0CAA <br /> 95201 <br /> PH.(2 <br /> PH.(209)4617109 <br /> DATE AMOUNT <br /> 7 DECEMBER,1993 $ 468.00 <br /> PAY FOUR HUNDRED SIXTY—EIGHT DOLLARS <br /> TO THE <br /> ORDER SAN JOAQUIN COUNTY, ENV' HEALTH DIV, TWO SIGNATURES REQUIRED OVER 5500.00 <br /> 221-225 MINER, TANK REMOVAL APPLICATION -- <br /> REPAIR FEE (Workplan Review 8 Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE - S78.00/hour (3 hours minimm/TANK) # TANK(s) X $234.00 • S <br /> A <br /> I TANK RETROFIT REPAIR FEE = S78.00/hour (3 hours min./FACILITY) _ $234.00 minimum S <br /> R <br /> PIPING REPAIR FEE = S78.00/hour d hours minimum/FACILITY) _ $234.00 minimum f <br /> M TRANSFER FEE _ S20-00 UNAUTHORIZED RELEASE EVALUATION = 578-00/hr f <br /> I <br /> S <br /> C CONSULTATION FEE 578.00/hr SAMPLING INSPECTION FEE = f78-00/hr S <br /> TOTAL DUE S 468 00 <br /> FOR OFFICE USE ONLY <br /> W IIY"WYwWY"°W","°wM"1WI"I�W WWM W"Y.WIC,�wWW,.WY".WW„WMW.WW"M.W""..WI,W.iMWI",I.W Y,MWIM".W�.W WII,".wW <br /> s a <br /> S <br /> Fw.W T,..WTtiwwwawwww Wrww"ww .wI�W""I.W�.W.,.,.W,W.W Wrrw" fW°w"1°wl°wYM°wwawaww WY"Ww <br /> ■%MaaM/NlfaMlYflallMaaaaaNlNa mMwaY pMM{m4AMMtaMlMMI/MiaMW IYIw YaMilMtwOlfMfmYW W1Y1w1maalslM malatMmt <br /> M/MafM�alYi ANaaMlaaiAatlMMMaa <br /> EH 23 032 (REVISED 3-1.93) 1W Pave 11 <br /> 1 <br />