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SAN JLV(GUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVSION <br /> UR)ERGRCIUND STORAGE TANK PROr" - FEE NORKSHEET <br /> 5 FACILITY SITE NAME FACILITY CONTACT NAME <br /> ndl E11x3H 5lb <br /> F FACILITY ADDRESS " I..1'�PH SITE PHONE R with AREA CODE <br /> t 1Jor Fh lei,l,�ornin.. ;-et <br /> ItY j.1 1uIG STATE ZIP CODE R of TANKS I <br /> +rxX--bn , <br /> A �zoy at SITE <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT AME <br /> I �) riJPx �nglrteerinq f Lp1nS�1'TAc1-Lol� <br /> i C MAILING ADDRESS APPLICANT PHONE R WITH AREA CODE <br /> A Q50I_VO4la)� Gnus 510 SILn-OIb2 <br /> I -- <br /> T CITY STATE ZIP CODE TYPE of APPLICATION iJSuA e- <br /> gT'E-n'�WOOc� CR 14SIS (Closure, Instaltat ion, ate.) <br /> TOTAL <br /> ff-%-170/TANK <br /> 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.j <br /> $ <br /> C _- /2-R� <br /> T FACILITY PENALTY FEES ASSESSED (If Appl(cable) fou (� <br /> I <br /> v TANK FEE _ $50.00/TANK (Prior to January 1,1991) January 1, 1991) <br /> F <br /> Tanks = 1986 1987 1988 198 1994 1995 1996 <br /> r (Noltiply Y by fee for A eneh year applicable) X%%X %%%% <br /> CI TANK PENALTY FEES ASSESSED %%%% %%%% � <br /> L <br /> 1 STATE SURCHARGE _ $56.00 each TANK (Due, every 5 veers, See rallfnrnin H 4 S r-rv/e s'"inn �R 797 <br /> e _ <br /> SUNRIVER ENGINEERING 2193 <br /> III CONSTRUCTION, INC. 90-388111211 <br /> 4501-D O'HARA AVE. 510-516-0162 AUG 17 1993 <br /> BRENTWOOD, CA 94513 <br /> j 19�� <br /> TO ` ENVIRONMENTAL H <br /> ORDER L pERMITISERVICES 1 $1 (000 - <br /> -::- <br /> 1 j_00 — <br /> �4�, ORDER OF LLJ <br /> �p <br /> O o ILARS <br /> Q Donk of Livermore <br /> 1125 aECONG STREET-LA ERMORE.CALIFORNIA 0460 <br /> Fon <br /> 00i635530,10 <br /> 1TANK RETROFIT REPAIR FEE = $78.00/hour (3 hours min./FACILITY) • $234.00 mini muni t <br /> R <br /> I PIPING REPAIR FEE _ $78.00/hour (3 hours minimum/FACILITY) : $234.00 minimin t <br /> M TRANSFER FEE = 520.00 UNAUTHORIZED RELEASE EVALUATION - $78.00/hr $ <br /> I <br /> 5 -- <br /> C CONSULTATION FEE = S78.00/hr SAMPLING INSPECTION FEE _ $78.00/hr $ <br /> TOTAL DUE IS (6)QTD <br /> FUR OFFICE USE ONLY <br /> ._.. PRPT:-:! M.M.lmr=!v!mne3[,=gym�innr'r,.9^.9!!IT!n:T^'rl., m.^f^'!.*.i;gy?Lm^,^,T+e91!:T.!!!l!rrAL .m.^m,rymllm!!!!mnmvgmmT,q.T.-,-",mt-^mT9n...... .LR1!D1�En.. .,�.., <br /> e <br /> il"PMIT z; C N..Imq.m!.'1.411 li it ......i'I t i 9'i 44 ..... '14_4..!..P�. . 1 i I. L. 'i 9 <br /> ♦ SWEEPS N COMPUTER R LOC CODE DIST CODE AMOUNT RECEIVED HE /CASH RECEIVED BY DATE RECEIVED <br /> $ 01> <br /> mm.mmmrwrt * <br /> ,. � :r . ,r ,wt . ;.: rv:4:a :: 8 <br /> v...a <br /> Ell 23 032 (REVISED 6-21-V Page it p <br />