Laserfiche WebLink
SANINdCAQUIN LOCAL HEALTH DN.dTRICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> P FACILITY/SITE NAME _ — – — FACILITY C TA""CT��NAMEE <br /> I1Cj �la{v /11�c��L L>�SIci✓ 1 �i6E� �if . c <br /> L STREET ADDRESSNIT <br /> TREA COOK <br /> SIE PHONE N A� . '� 1 <br /> I <br /> Y CITY C_'I� I ✓ C j IIP CODE ataSitenks T 1 <br /> A APPLICANT/Bl l [NG NAME ( r - APPLICANT CONTACT NAME <br /> P WL { - iJv- _� T1Ci WOSjv �OSv� <br /> I MAILING ADORES / A PLICA T PHONE f WITH AREA CODE <br /> R CITY A TAT IIP CODE TYPE of APPLICATION <br /> CLOSURE. INSTALLATION, ETC. <br /> FACILITY�FEE = $100.00 each SITE ADDRESS per YEAR L!Y//'TOTALTf VVVYYY <br /> A ----—---------------- __ - <br /> T 1986 1987 __.. -_..._1988 --- -'1989 <br /> I <br /> V <br /> E TANK FEE _ $50.00 each TANK <br /> F 1 Tanks x $50.00 1986 1981 1988 1989 <br /> A (nultipry-1-by fee for --- - <br /> C each year applicable) <br /> I <br /> 1 STATE SURCHARGE _ $56_00 each TANK (see CA HEALTH 6 SAFETY CODE Sec 25287 for applicability) <br /> T 1 Tanks x 156.00 —1986 1987 1988 1989 <br /> Y (enter iiouit and year) — <br /> C PERMANENT CLOSUR (Removal or Closure-in-place) <br /> L - -- <br /> 0 CLOSURE FEE _ $90.00 each TANK 1 Tanks x 190.00 f <br /> S-- <br /> _ <br /> U <br /> E TEMPORARY CLOSURE (Only allowed one time for up to two years) ---_ <br /> - .. <br /> TEMPORARY CLOSURE FEE = $80.00 each TANK �I Tanksx $80.00 f <br /> P PLAN CHECK (Installation or Repair) — — <br /> L ------- -- _ —_.._.- ---- —.-.-. <br /> N FLAN CHECK FEE = 130.00 each SUBMISSION/RESUBMISSION f <br /> REPAIR �— <br /> P. TANK REPAIR FEE _ $110.00 each TANK 1.1 Tanks x $110.00 f <br /> F ---_-_-..._.__- ------ ---- <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hourr minimum one hour to be paid on plan submittal) <br /> I - ----. — —_---- — <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (when applicable) (when applicable) (when applicable) <br /> FEE = $30.00/hr FEE _ $35.00/hr FEE _ $35.00/hr f <br /> TOTAL DUE f <br /> OFFICE USE ONLY �QJ11 <br /> ORMIRSPIRIN PENNm .111,11 PMI,N. , A� lfuilallV�IRP�.�GV(119ip�IV@�1.1Vl�M�VVVWMA �I .IV@VCIi�I�V"11iAVIIVI'.V�lllp4"V":Vufil1i I..VMIVVVRVTaVIIIVVfi��N4 �Vi�IVI�IG91G'�d�V.4 <br /> P I I I , P <br /> SWEEPS 1 COMP 1 " LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK 1/CASH RCVD BY DATE RECEIVED PERM)T i <br /> �PP1gll M"Vp.ImilM l61, I IIMma,11VMI 19�i�V�IxI V mml �VV�I !P,�IV—, I��@9G n I�V�kI��V V�N MVIVN�VI �IB�I�I�III�BMI� — <br /> S LE)OR11 32z <br /> I,mi0 p i"�k 'I.r B I II V; I E: . !4 V alml �BmMM mmml llm l!:I <br />