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- - 1I 11A <br />..r.�J Uri%wU 114 Lva;ML hc'HL l rl L j-1 <br />UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br />F FACILITY/SITE NAME <br />FACILITY FEE = $100.00 each SITE ADDRESS per YEAR <br />FACILITY CONTACT NAME <br />A <br />TOTAL <br />A <br />CCFrank's Exxon #2 <br />U <br />JerryIloore <br />t STREET ADDRESS <br />C <br />T <br />SITE PHONE t (with Area Code) <br />TQ East Yosemite Avenue <br />1987 <br />20� E? —2 r -O <br />Y CITY <br />$ <br />STATE <br />TIP CODE <br />t of TANK'S <br />1'isnteca, CA <br />FEE _ $35.00/hr <br />CA <br />95336 <br />at Site Four (4) <br />A APPLICANT/BILLING NAME <br />P <br />1 <br />V <br />APPLICANT CONTACT NAME <br />P B & C Construction Company <br />TANK FEE = $50.00 each TANK <br />Bill Bechthold <br />L <br />F <br />A <br />t Tanks x $50.00 <br />(multiply -t -by fee for <br />I MAILING ADDRESS <br />C <br />1987 <br />APPLICANT PHONE t (with Area Code) <br />5537 N Pershing, A-3 <br />(209) 951-9304 <br />N CITY <br />T Stockton, <br />ICA <br />STATE <br />ZIP CODE <br />95207 <br />TYPE of APPLICATION <br />(Closure, Installation, etc.) CLOSURE <br />C <br />L <br />FACILITY FEE = $100.00 each SITE ADDRESS per YEAR <br />0 <br />TOTAL <br />A <br />f 7600 <br />U <br />C <br />T <br />TEMPORARY CLOSURE (Only allowed one time for up to two years) <br />1986 <br />1987 <br />1988 <br />1989 <br />$ <br />FEE = 130.00/hr <br />FEE _ $35.00/hr <br />FEE _ $35.00/hr <br />$ <br />Ar•. <br />$ <br />1 <br />V <br />E <br />TANK FEE = $50.00 each TANK <br />PAYMENT <br />F <br />A <br />t Tanks x $50.00 <br />(multiply -t -by fee for <br />1986 <br />1987 <br />1988 <br />1989 <br />=JTA-1 <br />19 <br />C <br />I <br />each year applicable) <br />L <br />t <br />STATE SURCHARGE = $56.00 each TANK (see CA HEALTH i SAFETY CODE Sec 25287 for applicabilit <br />T <br />Y <br />t Tanks x $56.00 1986 1987 1988 <br />(enter mount and year) <br />1989PE <br />ITMAL <br />SE <br />f <br />C <br />L <br />PERMANENT CLOSURE (Removal or Closure -in-place) <br />0 <br />CLOSURE FEE = $90.00 each TANK <br />t Tanks __ z (90.00 <br />f 7600 <br />U <br />R <br />E <br />TEMPORARY CLOSURE (Only allowed one time for up to two years) <br />UNAUTHORIZED RELEASE EVALUATION <br />(when applicable) <br />TEMPORARY CLOSURE FEE = 180.00 each TANK <br />- <br />t Tanks _ x f80.00 <br />$ <br />PIPLAN CHECK (Installation or Repair) <br />L <br />A <br />N PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION $ <br />REPAIR <br />R <br />E TANK REPAIR FEE = $110.00 each TANK <br />P <br />t <br />Tanks z (110.00 <br />f <br />I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br />R <br />UNAUTHORIZED RELEASE EVALUATION <br />(when applicable) <br />CONSTRUCTION <br />INSPECTION <br />SAMPLING <br />INSPECTION <br />FEE = 130.00/hr <br />FEE _ $35.00/hr <br />FEE _ $35.00/hr <br />$ <br />Ar•. <br />TOTAL DUE <br />$ q b o 0 <br />v�r.�C YJC VRLI <br />IIIIIII.IIII I <br />