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4-25-1993 09123AM �RUN f0 4785046 P.04 <br /> r SAKI JOAOUI " PtIILIC HEALTH SERVICES - ENV1ROMMENT TN UIVSION <br /> EfEIRGtitaL= STCIRAGE TANK PROMM - FEE UORis <br /> s FACILITY SITE NAME FACILITY CONT NAME <br /> 1 TLJF, ruckinglnc . <br /> -Lee Jennings <br /> E FACILITY ADDRESS SITE PHONE E with AREA CODE <br /> * a15 Moffet Blvd. 200 823-0071 <br /> CITY TCA <br /> P ZIP CODE 0 of TANKS <br /> Manteca at SITE One <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT HAKE <br /> L -B_&. C .C_onetruCtion Company Gar Crowder <br /> I — <br /> C MAILING ADDRESS APPLICANT PHONE R WITH AREA CCOE <br /> " N Pershin , <br /> H A- q <br /> R 3 209 ) o�1-. 304 <br /> T CITY STATE zIP CODE.J(Ctosura, <br /> TYPE of APPLICATION ATG Installatio <br /> CIL P F:2 C 7 InsteLLation, ate,) <br /> IOTAL <br /> -- 198b 1987 1488 19$9 1940 <br /> -� ec«is oeLiv€aF.o rors vn4.gre r -- -- <br /> �OLLow,t✓G ._. <br /> CONSTRUCTION <br /> �1 _CO 5637 N. PERSHING AVE., SUITE A-3 951-93D4 <br /> Tl STOCKTOIV, CA 952D7 90-IDB!1211 <br /> .� � ! - PAY I9 3 <br /> PUs3LlCr,� i �;. TO THE 1 I S (3 C) <br /> ><IN ICllfl' ORDER OF <br /> - - - -- — - <br /> ENVI{ 4,,1�'i`_'N,./:M€ <br /> 0 <br /> ^. i-i 11', W C l l3►� w•- C! r_( i o/ <br /> - - - -u `�. - - r ca o.D 0 L L.A R S <br /> UNION SAFE 8307 <br /> DEPOSIT BANK <br /> 5555 N.Pershing Ave.,st"kion,CA 95207 <br /> 11' <br /> TEMPORARY CLOSURE (Dien Review R Inspections) - --—- TANK I.D. l(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = '!7$,00/hour (3 hours minirntn/TANK) 0 TANK(s) X 5234.00 = _ <br /> P INSTALLATION PLAN CHECK (Paan Review 91C Inspeetions) TANK J.D. #(3) <br /> L <br /> A <br /> N PLAN CHECK FEE ■ $78.00/hour (8 hours ellnimun/FACILITY) $624.00 minimum = <br /> R REPAIR FEE (410rkpLsn Review & Construction Inspection$) TARK I.D. 0(s) <br /> E <br /> P TANK LINING REPAIR FEE - S78.00/hour (3 hours minimus/TANK) # TANK(s) % 1234,00 = S <br /> A <br /> I TANK RETROFIT REPAIR FEE a 578".00/hour t3 hour$ min./FACILIYY) = 1234.00 minimum 1 J•C <br /> R <br /> =mG <br /> PAIR FEE _ $78.00/hour (3 hours minimLWFACILITY) ■ $234.40 minimum x <br /> M TRANSFER FEE 4 $20.00 UNAUTHORIZED RELEASE EVALUATION = $78,00/hr : <br /> I <br /> S <br /> C CONSULTATION FEE = 178.00M P SAMPLING INSPECTION FEE 178.0whr g <br /> TOTAL DUE $ <br /> FOR OFFICE USE ONLY <br /> h:: E:'.:InrX'_Vhiv-rriiim112!],s. i�. .. z....r i}FiFti.-.__ s IIIIEiis r .r..... , <br /> i" a,n, i " nniv'=:'as: lYE r.`:�r-:gpy niyKMT:rax�9 Rnii:n.^::?a4.E4 0Y�r-=:dSU1: - --r.�i �•. <br /> "-..�9.fin ='-"`...... 11..h:::--..:::cra:' lir r pial!!is-_;:;iii-i ::_:::r:-"_ '�:•-:-=::a;:"f{cn:_•: q�[R_so.n_.. ru.di.a2i!ft91 GIF.`.:n <br /> n Su£EPs �{ �I u13sC:.__,._CASI- RE .t°FWlllt:_—c aitljis_:=::: mIRIIUIL: I!Inll <br /> COMPUTER !f LOC CODE D[ST CODE 0.kOUNT RECEIVED CHECK H/CASH RECEIVED BY DATE RECEIVED y <br /> a <br /> F2 <br /> 15 7/, <br /> r <br /> L <br /> ' 15Y7RqrAMtin p G•fir• 1 G,2_ �_/ Y / l r - pp r T <br /> 1'I..,FIIIffP!P-_.Y...19gGlII I •_! 'PW(k'P'3fPJl lu..^_` iplfNGi:.�:�1� <br /> 3m mnb riNFF1.Arm$Ifll7at•*Fr''J" S}IfClsrrry.�.11!IhIIGnI 'G�P4t J.3 fl'IiL dam~•-llIIMItEFl.�lil Eft IG <br /> r u.:ailkY INtRgy+Huii94l1iJWlWr�..�,�idlllAliPiS sliliFT_=E!1:11 , ._ <br /> gT2E67r..d I _evr. <br /> URINE:�•-'31! , !" i : . � tlH <br /> EH 23 032 (REVISER 11'-1.92) Page i1 <br />