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RED[-NOTE DATE _ism <br /> To r <br /> SUBJECT <br /> �J— <br /> j' f <br /> SIGNED TOTAL <br /> REDIPORM„ 45462 Q NO REPLY NECESSARY Q REPLY REQUESTED - USE REVERSE SIDE <br /> POLY PAK (50 SETS) 4P462 carbon/eas <br /> t IANx tLE _ $50.00 each TANK <br /> f i Tanks _ x $50.00 1986 1987 1`$88 <br /> A (ouItIpTv T-h I. __-_ _ _ <br /> I <br /> L <br /> STATE SURCHARGE _ $56.00 each TANK (see CA HEALTH $ SAFETY CODE Sec 15187 for applicability) <br /> T t Tanks x $56.001986 1987 1988 1989 <br /> Y (enter 5aouot and year) <br /> t <br /> I F <br /> C PERMANaCLOSURE (Resovaloval or Closure-in-place) <br /> LO CLOSUReach TANKt Tanks x f9U.00S U - <br /> R TEMPORy allowed one tine for up to two years) <br /> ETEMPOR $80.00 each TANK <br /> I Tanks z $80.00 y <br /> P PLAN 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 1 Tanks x $110.00 ; <br /> A <br /> 1 PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, siniaua one hour to be paid an plan subaittal) <br /> R <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTIONcr_ SAMPLING <br /> (when applicable) INSPECTION �„ /y <br /> INSPECTION <br /> FEE _ $30.00/hr FEE _ $35.00/hr ,� <br /> FEE = f�.,.001hr <br /> $ <br /> DfFZCE USE ONLY TOTAL DUE _I <br /> SWEEPS t COMP Y LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVO CHECK 1/CASHRCVD BY DATE RECEIVED PERMIT 1 <br /> Z_ -- <br /> •911M14 F f ( <br /> a . i w.,.!W IF. ' :��iY✓Wvv� <br />