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f - I <br /> SAN JOAw=jIN LOCAL HEALTH DISTRI ., <br /> 1 <br /> UNDERGROUNI BiORASE TANK PROGRAM - FEE NORKSHEET <br /> -"- FACILITY CONTACT HANE <br /> LITY/SITE NAME <br /> SITE PHONE 1 us'" AeeA Nee <br /> STREET AIDRESS�/ <br /> Tr / IV HT 11P CODE 1 of Tanks <br /> Y CITY ( at Site <br /> APPLICANT CONTACT NAME <br /> A APPLICANTIIILLIIN {' .; /- / S I <br /> P � - 117 . c,n <br /> P I�Clic _ <br /> L APPLICANT PHONE 1 YI1M 1.111+ ane <br /> I KAILIIN AM�ESI L S �—S <br /> N Clil D. i� 81 11001E �, ai ANOW, Ito. <br /> - � TOTAL <br /> FACILITY FEE 1100.00 each SITE ADDRESS per YEAR <br /> A 19(16 1987 1981 1989 <br /> C i <br /> T <br /> I <br /> V _ <br /> E TANK FEE • 150.00 each TANK _ ._ <br /> f 1 Tanks _ _ s 150.00 1986 1981 1988 1989 <br /> A Oultlplj 1 by lee for 1 <br /> C uch year applicable) <br /> i <br /> L STATE SURCHARGE • 156.00 each TANK (see CA HEALTH I SAFETY CODE Sec 25287 for +pp1iu61UlY <br /> I 1986 t9B7 1988 1989 <br /> f 1 Tanks_____ s 156.00 1 <br /> Y (eater aeouit and year) <br /> C PERMANENT CLOSURE (Removal or Closure-in-glue) <br /> L 1 Tanks s 190.00 1 d� <br /> S CLOSURE FEE • 1190.00 lick TANK <br /> U <br /> R iEHPORARY CLOSURE (Only allowed one time for up to two years) 1 <br /> E TERPORARY CLOSURE FEE • $80.00 each TANK 1 Tanks------ a $80.00 <br /> P PLAN CHECK (inslallatloo or Repair) <br /> L <br /> A1 <br /> N PLAN CHECK FEE $30.00 each SUBMISSION/RESUBMISSION <br /> REPAIR <br /> 1 cants______ a 11110.00 1 <br /> R TANK REPAIR FEE • $110.00 each TANK ---- <br /> E <br /> P <br /> A p1PIN8 REPAIR/CLOSUREIRENOVAL (fees are per hour, minimum one hour to be paid on plan submittal) <br /> I <br /> R UNAUTHORITEI RELEASE EVALUATION CONSTRUCTION INSPECTION Sy1hIPl1�6 1N5;bil�ON <br /> (when Applicable) (when applicable( pp <br /> FEE • /35.00/hr FEE • $35.001hr $ <br /> FEE • 130.00/hr — gc <br /> TOTAL TUE 1 <br /> OFFICE ISE ONLY <br /> fNEEPB 1 COMP 1 IOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK I/CASH RCVI Il DQE RECEI�) PERMIT 1 <br /> t <br /> Z3 R qNr r 2 ?Z9 c fico- G <br />