Laserfiche WebLink
DERBROUND STORAGE TANK PROGRAM - FEE NORKShew <br /> f FACILITY/SITE NAME <br /> A FACILITY CONTACT NAME <br /> G <br /> I - <br /> L STREET ADDRESS <br /> I ) SITE PHONE 1 (with Area Code) <br /> YCITY )0 , C- 5 Q ' <br /> TATE ZIP CODE 1 of TANKtS <br /> at Site <br /> PAPPLICANT/84LING NAME APPLICANT CONTACT NAME <br /> I MAILING ADDRESS <br /> A > ! APPLICA PHONE91 with Area Code) <br /> N CITY _ _ c— c <br /> T TATE IIP CODE • T 1 APPLICATION <br /> t losure' Installation, etc.) <br /> A FACILITY FEE a $100.00 each SITE ADDRESS per YEAR TOTAL <br /> C1986 1987 1988 1989 <br /> T <br /> 1 <br /> V $ <br /> E TANK FEE ■ 150.00 each TANK <br /> F 1 Tanks s $50.00 1986 19G7 1988 1989 <br /> A (multipiy-t-by Ewe for <br /> [ each year appilc It) <br /> I 1 <br /> I STATE SURCHARGE = 156.00 each TANK (see CA HEALTH k SAFETY CODE Sec 25287 for applicability) <br /> T t links . , x 556.00 1986 1987 1988 1989 <br /> Y (enter imount and years <br /> t <br /> ESURE (Removal or Closure-in-place) <br /> f90.00 each TANK 1 Tanks_ x f90.00 $ <br /> SIIRF IOnly allowed one limo for up to Iwo years) <br /> URE FEE : $80.00 each TANK 1 Tanks x f80.00 t <br /> IP PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> N PLAN CHECK FEE • 530.00 each SUBMISSION/RESUBMISSION <br /> s <br /> REPAIR <br /> R <br /> E TANK WAIR FIE • tII0.5 each TANK <br /> P 1 ranks z {110.00 $ <br /> A --- <br /> 1 PIPING REPAIR/CLOSURIIRENOVAL (rata are pat I.w,, <br /> R ■Inlmam one hour to oe pall on plan submittal) <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION ) .. SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> IEE m S30,00/hrl FEE • 175.00lhr FEE • $35.00lhr 1 <br /> f <br /> OfflCf B9f ON(Y TOTAL DUE <br /> SWEEPS 1 COMP 1 LOC CODE OIST CODE AMOUNT OUE AMOUNT RCVD CHECK t/CASH RCVD BY DATE RECEIVED PERMIT 1 <br />