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.0 6 UHwU 1 iv LuL:HL f tGHL l h V. 1 K 1 �.; 1 <br />HNURG2nl1Nn S MW TAUV PonroAm _ ree unoveurry <br />F <br />A <br />FACILITY/SITE NAME <br />FACILITY CONTACT NAME <br />A <br />Frank' s Exxon #2 <br />Jerry P•io o re <br />L <br />STREET ADDRESS <br />SITE PHONE $ (with Area Code) <br />T1390 <br />East Yosemite Avenue <br />209 F3F-2r-0 <br />Y <br />CITY <br />FSTATEZIPCODE <br />t Tanks x $80.00 <br />of TANK'S <br />l-anteca, CA <br />A <br />95336 <br />at Site Four (4) <br />A <br />P <br />APPLICANT/BILLING NAME <br />APPLICANT CONTACT NAME <br />P <br />L <br />B & C Construction Company <br />Bill Bechthold <br />I <br />MAILING ADDRESS <br />APPLICANT PHONE t (with Area Code) <br />A <br />F637 N Pershing, A-3 <br />(209) 951-9304 <br />NL <br />1Stockton, <br />CITY <br />FSTATEIZIP <br />CODE <br />95207 <br />TYPE of APPLICATION <br />(Closure, Installation, etc.) CLCSURE <br />C <br />L <br />FACILITY FEE = 5100.00 each SITE ADDRESS per YEAR <br />TOTAL <br />A <br />CLOSURE FEE _ $90,00 each TANK <br />t Tanks_ __ x $90.00 <br />C <br />U <br />1986 <br />1987 <br />1988 <br />1989 <br />T <br />t Tanks x $80.00 <br />$ <br />$ <br />1 <br />V <br />E <br />TANK FEE _ $50.00 each TANK P A Y M E N T, <br />F <br />1 Tanks x $50.00 <br />-1 -by <br />1986 <br />1981 <br />1'388 <br />1989 <br />A <br />(multiply fee for <br />J A <br />1 7 1 9 8 <br />C <br />I <br />each year applicable) <br />L <br />I <br />STATE SURCHARGE _ $56.00 each TANK (see CA HEALTH 6 SAFETY CODE Set 25287 for applicabilit <br />T <br />Y <br />I Tanks x $56.00 1986 1987 1988 1989PE IT I <br />(enter mount and year) <br />$ <br />C <br />L <br />PERMANENT CLOSURE (Reaoval or Closure -in-place) <br />0 <br />S <br />CLOSURE FEE _ $90,00 each TANK <br />t Tanks_ __ x $90.00 <br />$ <br />U <br />R <br />E <br />TEMPORARY CLOSURE (Only allowed one tine for up to two years) <br />TEMPORARY CLOSURE FEE _ $80.00 each TANK <br />t Tanks x $80.00 <br />$ <br />' PLAN CHECK (Installation or Repair) <br />4 <br />I PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION $ <br />REPAIR <br />R <br />E TANK REPAIR FEE _ $110.00 each TANK <br />P 1 Tanks _ z $110.00 $ <br />--- <br />A <br />I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, oinivue one hour to be paid on plan suboittal) <br />R <br />UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION SAMPLING <br />(when applicable) INSPECTION INSPECTION <br />FEE _ $30.00/hr FEE _ $35.00/hr FEE _ $35.00/hr $ <br />TOTAL DUE IS 9602 <br />OFFICE USE ONLY <br />