Laserfiche WebLink
--I% 4UAwUlI4 LUCAL HEALTH DI^l'HIC1- <br />IERGROUND STORAGE TANK PROGRAM - FEE NORKSHEc,- <br />FACILIIY/SITE NAME FACILITY CONTACT NAME <br />�1 fl-e.v <br />STREET ADDRESS <br />SITE PHONE 1 WITH AREA coma <br />CITY STAT / TIP CODE 1 of Tanks <br />at Site <br />APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br />CIMAILING ADDRESS <br />I CITY <br />FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR <br />—� 1986 1987 <br />APPLICANT PHONE t WITH AREA CODE <br />TIP CODE TYPE of APPLICATION <br />GLOWUAE. IHmTALLATIOH. ETC. <br />1988 1 1989 <br />ETANK FEE = $50.00 each TANK <br />F 1 Tanks_ _ r $50.00 1986 1987 198A <br />A (multiply I by tee for 1989 <br />C each year applicable) <br />1 <br />L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH 6 SAFETY CODE Sec 25287 for applicability) <br />I <br />T 1 Tants t 156.00 1986 1987 190 — <br />Y (enter iiount and year) 19899 <br />lgio <br />E (Removal or Closure -in-place) <br />190.00 each TANK (90.00 <br />E (Only allowed one time for up to two years) <br />E FEE = $00.00 each TANK t Tants E t80.00 <br />EPLAHECK (Installation or Repair)ECK FEE _ $30.00 each SUBMISSION/RESUBMISSION <br />REPAIR <br />TANK REPAIR FEE _ $110.00 each TANK1$110.00 <br />00 C <br />Tanks z fll0 00 1i <br />PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan subs <br />UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br />(when applicable) (when applicable) (when applicable) <br />FEE _ (30.00/hr FEE = (35.00/hr FEE <br />OFFICE USE OILY <br />TOTAL DUE <br />F <br />.# <br />S <br />f <br />I <br />TOTAL <br />SWEEPS 1 I COMP 1 ILOC CODEIDIST CODEI AMOUNT DUE AMOUNT RCVD CH CK 1 ASH RCWY DATE RECEIVED PERMIT t <br />