Laserfiche WebLink
SMiw j AwUIN LUGHL HtrfLiH DYSjwjCl" <br /> UNOUGROUND STORAGE TANK. PROGRAM - FEE WORKSHEET <br /> F FACILITY/SITE NAME FACILITY CONTACT NAME <br /> A <br /> L STREET ADDRESS SITE [ ONE I (with Area Code) <br /> Mei c8 —8333 <br /> Y CITY ST TE CODE I of TANK'S <br /> cS za C at Site /Ve <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> LP <br /> I MAI ING AD SS APPLICANT PHONE I (with Area Code) 69 <br /> A _o _ <br /> N CI STl�E Z[P CODE TYPE of APP <br /> T /1 �.40� (Closur , nst dation, etc.) <br /> A FACILITY FEE = $100.00 each SITE ADDRESS per YEAR TOTAL <br /> T 1986 1987 1988 1989 <br /> 1 $ <br /> V <br /> E TANK FEE _ $50.00 each TANK <br /> F I Tanks x $50.00 1986 1987 1988 1989 <br /> A (multipry 1-by fee for <br /> I each year applicable) Is <br /> L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH I SAFETY CODE Sec 25287 for applicability) <br /> I i <br /> T I Tanks z $56.00 P <br /> 6 1987 1988 1989 <br /> Y (enter 5oount and year <br /> I s <br /> C PERMANENT CLOSURE (Removal or Closure-in-plate) <br /> L <br /> 0 CLOSURE FEE = $90.00 each TANK I Tanks x $90.00 $ <br /> S -- <br /> U <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E <br /> TEMPORARY CLOSURE FEE = $80.00 each TANK I Tanks x $80.00 $ <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> N PLAN CHECK FEE _ $30.00 each SUBNISSION/RESUBMISSION $ <br /> REPAIR <br /> R <br /> E TANK REPAIR FEE _ $110.00 each TANK I Tanks z $110.00 $ <br /> P Tanks.... <br /> 1 PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <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 is `7 p <br /> TOTAL DUE Is 16)p <br /> OFFICE USE ONLY <br /> SWEEPS k COMP I LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK /CASH RCVD BY DATE RECEIVED PERMIT I <br /> /1177 =9 a ,) 33aS 8"l—t� <br /> u <br />