Laserfiche WebLink
anN JUAWUaIv LUCAL htALIH UISlklGI <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> F FACILITY/SITE NAME FACILITY CONTACT NAME <br /> A <br /> C Fivxp s7/7Jv ,, r e 6bco, <br /> LSTREET ADDRESS SITE PHONE t (with Area Code) <br /> T V&Z5ee re (aoA 751 <br /> Y CITY STATE ZIP CODEt o TANK'S <br /> 01 9 J 0 at Site <br /> AA APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE f (with Area Code) <br /> C <br /> A <br /> N CITY STATE ZIP CODE TYPE of APPLICATION <br /> T (Closure, Installation, etc.) <br /> A FACILITY FEE = $100.00 each SITE ADDRESS per YEAR TOTAL <br /> T 9 <br /> 1986 1987 1988 198 <br /> I P <br /> V <br /> E TANK FEE = $50.00 each TANK R E C E I V E D <br /> F t Tanks x $50.00 1986 1987 1988 1989 <br /> A (multiply i-by fee for <br /> I each year applicable) $ <br /> L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH $ SAFETY CODE Sec 25287 for applica i it ENTAL HEALTq <br /> I <br /> Tr(Loteafit'and <br /> 156.00 1986 1981 1988 1989 <br /> Y year) <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L <br /> 8 CLOSURE FEE = $90.00 each TANK t Tanksr_ x $90.00 f g� <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 t Tanks x 180.00 f <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> N PLAN CHECK FEE = $30.00 each SUBMISSION/RESUBMISSION f <br /> REPAIR <br /> R <br /> E TANK REPAIR FEE = 1110.00 each TANK $ Tanks x $110.00 4 <br /> p <br /> A <br /> R PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE = $30.00/hr FEE = $35.001hr FEE = $35.00/hr f <br /> TOTAL DUE Is <br /> OFFICE USE ONLY <br /> SWEEPS t COMP t LOC CODE DIST CODE I AMOUNT DUE I AMOUNT RCVD I CHECK t/CASH RCVD BY DATE RECEIVED PERMIT t <br /> ?-7 a i0 <br /> •9'+'.,r: "'+Ig i-•yr.b:'Pf "�. N CI#ja,P�r ��%. .'�-.4�Aya-i.�9R�_0. i/Ace� .. <br /> viz 1MR1 <br />