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<br /> SAN JOAC?U I N L_UC;/II- I IL_t1L1_11 D 151"IR I C7
<br /> .*GROUND STORAGE TANI; PROGRAM - FEE WORKSHEE•
<br /> _._..... ........._._.._.._:_........._..._.......;_.._.....__ _ ....
<br /> ...
<br /> ..........
<br /> ...---
<br /> -----
<br /> ---
<br /> -•--_-----
<br /> F ;CILHTISITE NAME (FACILITY r;Ot1TArT NAME
<br /> — Precissi Flying Service John Precissi
<br /> y
<br /> L STr.�ET AJDFESS SITE PHONEY WITH AREA CODE
<br /> T — > -919--M _.__L_4wer Sacramento Road ( 209 ) 369-4408
<br /> Y CITYII'll i3OOC I of Tanks
<br /> Lodi, CA 95242 at Site one ( 1 ) 10 , 000 gallo {
<br /> I— - --- ----- ........ ..... .... _........_......._�
<br /> AI APPLICANT/BILLING NAME APPLICANT CONTACT NAM a3 ror� -ts tank
<br /> z.
<br /> L r -._F_l.yin,g,...__Service Same
<br /> ....... ..................
<br /> I IMAILING ADDRESS APPLICANT PHONE I WITH AREA CODE
<br /> JA
<br /> Same
<br /> __.._.............CITY ;TATE iIf' CODE TYPE 0APPLICATION
<br /> -.- .._. 01.00 un t_ IHOTAI.!_ATIOH, CTC.
<br /> _._._.........._............_.................................... .........
<br /> FACILITY FEE = SIr1tl.ilil - ADHESS� ,�. ...........---____._....---------------1---
<br /> A _ each SITE ,AD ESS per YEA,' TOTAL {
<br /> C I +96 �.�.`.�...._._. I`109 1709 P
<br /> T ---.--......._......---..._...._.- 1 ) g
<br /> o i
<br /> I
<br /> S
<br /> ��' ------------.,-----................... ..........
<br /> E TANK FEE $50.00 each TANK
<br /> F I Tanks (_ $50,00
<br /> A (►ultipTy-t by fee To.- ------ - - _..._.._ . _.... .. .. ............... -......-....
<br /> _._._�cL1�-- ,
<br /> C each-year applicable) I s s
<br /> 1 _
<br /> 1 STATE SURCHARGE = 556.00 each TANI; ;see CA HEALTH 4 SAFETY CODE Sec 25407 for applicability) t�
<br /> T I Tanks X_z. 556.00 1996 1907 1100 140'1
<br /> Y (enter a.ount :and year) i_._..------.._..-.--_..._.I..._.._._.._-._._. 199c�
<br /> r
<br /> t ,
<br /> -1.........._.._.._._..._..L_.._,.__.._...._..._........_.__ S�o S �ce j
<br /> 1• PEP.?SANENL CLOSURE7"
<br /> ..........._...._....__...._..._... ---- --
<br /> L .--..........._.......---.._.._.
<br /> 0 CLOSURE FEE = 540,00 each TAtir I Tanis z $40.00 $
<br /> S —- ---- _ --..............__..............._..._. ......... ...._.._.`..........._-.-.-.:-. ----
<br /> S TEMPOPAPY CLOSUP.E (Onlyt ,, - - — - —
<br /> �l,ovea ��e ne years)
<br /> E —=------:_..- _�....---...-........................__................__._. ;
<br /> .
<br /> TEriPOP.AF.1' I:L03UF,E i[ T „} _......._.............. - — -- ;
<br /> `or up t�� tvo
<br /> - ,.,: is --- E90.
<br /> • n I,5 ,. ()l)�
<br /> ...................._._..............- t
<br /> IP PLAN CHECK ('Installation or %epair. j
<br /> A -
<br /> III PLAN CHECK.FEE = 13;1,00 each SUD?S[SSI011/nESUDfiiSSION $
<br /> _._...- - ..._._.._._.__...._.......- ..._....-..........._-..................
<br /> _—
<br /> --
<br /> }
<br /> F. TANK' REPAIR, FEE 5110.00 each TAI(}; [ an�:s I Tz 5110,00E ----- - - - . _ ------
<br /> F
<br /> A PIPING REPAIR/CLOSURE/RE"OVAL (Fees are per hour, aini,aua one hour to be paid on plan subnittal) '
<br /> I _ s
<br /> R UNAUTHORIIED RELEASE.EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION — t
<br /> (vhen applicable) (when applicable) (vhen applicable)
<br /> ------------
<br /> FEE535.00/..r ,,
<br /> I r�E $3 .00/hrl
<br /> TOTAL DUE S BG
<br /> OFFICE USE OYE11- T
<br /> t'.FIL'L1�..'''.".iN_'^,E'1.'F`� il�j��alll��;ll:I'�i�.'u`:•r;�u4ilij�I�T�(Iit!I Pull j i'I 1„ II'�i17 1l'� , chill' � � ,uii fnI'n,�, i' , I , 'i! i' i '"I 11 , �•
<br /> iM�.. o ':
<br /> , 1 Icy.L,L,,I,�I��.hLV91.II�tUil.11d�.�.I,�llu.,ll(IVIIp�Cd.ilVllil.IIIIIIVV,dl,k6ih�ll!i11161GII6111r�119691[Ilpll!,l!6�1i1!f�l,il!Vfilirl!IG f��6t'�11f8�?If 9 ' ",rE
<br /> EPS I C LO;. LODE CISi CODE r1UNT DUE AMOUNT RCIr'D CHECK „/CASH RCYD 0Y DATE EECEIVED I PE?1Ii #
<br /> mpI9ru!rI!4!I!1 !i'I!' >���r� r .pinr : .Gi,r ! . 1119 � - — — ;
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