Laserfiche WebLink
"Awuliv LUUAL HI eALTH DIF 2IC1' <br /> w RGROUND STORAGE TANK PROGRAM - FEE YORKSHEEI— <br /> F FACILITY/SITE NAME FACILITY CONTACT NAME <br /> A <br /> C Mot r[ n EDF <br /> L STREET ADDRESS SITE PHONE 1 WITH AACA CODE <br /> T <br /> Y CITY STAT 21P CODE 1 of Tanks <br /> at Site <br /> A APPLICANT/BILLING NAME <br /> P APPLICANT CONTACT NAME <br /> P `M�o Rdderf <br /> L � <br /> I MAILING ADDRESS APPLICANT PHONE 1 <br /> C 9�/ ��,� YITM AAEA comm <br /> A _e <br /> N CITY <br /> T STA ZIP CO o PLICATION <br /> 5 cIDEUA E, wR wLLwlIOM, are. <br /> A FACILITY FEE = t100.00 each SITE ADDRESS per YEAR <br /> TOTAL <br /> C 1986 1987 1988 1989 <br /> f <br /> I <br /> V 4 <br /> E TANK FEE = 150.00 each TANK <br /> F t Tanks s 450.00 1986 1987 1988 1989 <br /> A (multiply"I-by lee for <br /> C each year applicable) <br /> I d t <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH 1 SAFETY CODE Sec 25287 for applicability) <br /> 1 <br /> T 1 Tanks x $56.00 1986 1987 1988 1989 <br /> Y (enter Mount and year) <br /> t <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L <br /> D CLOSURE FEE = 490.00 each TANK t Tanks x 490.00 <br /> S 4 <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 $80.00 <br /> t <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> N PLAN CHECK FEE = $30.00 each SUBMISSION/RESUBMISSION <br /> t <br /> REPAIR <br /> R TANK REPAIR FEE = 1110.00 each TANK <br /> E 1 Tanks x 4110.00 t <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> I <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION <br /> (when applicable) SAMPLING INSPECTION <br /> (when applicable) (when applicable) <br /> FEE : 430.00/hr FEE _ $35.00/hr FEE = 435.00/hr <br /> _ t <br /> 1 <br /> OFFICE USE ONLY TOTAL DUE <br /> SWEEPS 1 COMP 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT RC CHECK CASH KCVO BY DATE RECEIVED PERMIT t <br /> r <br /> W7�aw : �� � , S <br />