Laserfiche WebLink
... .nnn rnuonen rtt NUNRSMEET <br /> LAIDR TY/SITE NAME <br /> FACILITY C" �T NAME <br /> � r� EKtV� STf•� WfADDRESSg6 & lC TLErriAnl SITE PHONE t (with Area Code) <br /> �/J6gog - anal — D987 <br /> ool / Cl4L1F: SUTE 1�poeNK'SNT/BILLING NAME 9 ` APPLICANT CONTACT NAME <br /> � w E K . l . _ST6✓� �i�f2wDRESS APPLICANT PHONE t (with Area Code) <br /> ' d . f331 - 09 8 �Q TATE 11 CODE TYPE of APPLICATION <br /> } Z// (Closure, Installation, etc.) <br /> A FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR TOTAL <br /> C <br /> T 1986 1987 1988 1989 <br /> I <br /> V f <br /> E TANK FEE = $50.00 each TANK <br /> F t Tanks x $50.00 1986 1987 1988 1989 <br /> A (multipiy-1-by fee for <br /> C each year applicable) f <br /> I <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH t SAFETY CODE Sec 25287 for applicability) <br /> I <br /> T t Tanks x 156.00 1986 1987 1988 1989 <br /> Y (enter iiouit and year) <br /> f <br /> C PERMECLOSURE <br /> emoval or Closure-in-place) <br /> L <br /> 0 CLOS0 each TANK t Tanks __ x $90.00 f O .O O <br /> 5 <br /> U <br /> R TEMPnly allowed one time for up to two years) <br /> E <br /> TEMPE = 180.00 each TANK t Tanks x $00.00 f <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> N PLAN CHECK FEE = $30.00 each SUBMISSION/RESUBMissiom $ <br /> REPAIR <br /> R <br /> EE TANK REPAIR FEE _ $110.00 each TANK t Tanks __ x (110.00 f <br /> A <br /> I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> R <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE = $30.00/hr FEE = $35.00/hrFEE _ $35.00/hr $ <br /> TOTAL DUE $ <br /> OFFICE USE ONLY <br /> SWEEPS $ COMP 1 LOC COBE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK t/CASH RCVD BY DATE RECEIVED PERMIT t <br /> 13`IfI Wt � 3aa. 180 — go <br />