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• EY SERVICES - ENVIRONMENTAL <br /> TM DIK10M <br /> SAM JOADUIM ERDTRW TANK PROGRAM - FE UMKSXEET <br /> FACILITY CONTACW400E <br /> S FACILITY SITE NAME F <br /> ( SITE PHONE # with AREA CODE <br /> T <br /> E FACILITY ADDRESS <br /> STATE ZIP CODE at SITE KS One <br /> i CITY $7;C1C�Cto CA <br /> A APPLICANT CONTACT NAME <br /> P APPLICANT/BILLING NAME <br /> L APPLICANT PRONE # WITH AREA CODE <br /> 1 <br /> C NAILING ADDRESS 014 <br /> A <br /> STATE ZIP CODE (Closure- Installation, etc.) <br /> I CITY <br /> Red Bluff TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) _ $100.00 XXXX X%XX i <br /> A XXXX XIODf $ <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) $170/TANK (After January i, 1991) <br /> V TANK FEE _ $50.0 /TANK (Prior to January 1,1991) <br /> E 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> # Tanks = $ _ <br /> F each <br /> tyear Ti- y�fee for XX%X X%XX <br /> A each year applicable) E <br /> C <br /> I TANK PENALTY FEES ASSESSED %%X% XX%% <br /> L <br /> I STATE SURCHARGE • $56.00 each TANK (Due every 5 years) See California N $ S Code, Section 2528 <br /> 7 1986 through 1990 1991 through 1996 <br /> Y <br /> (Enteramount $ <br /> iinlmnwn �� <br /> place) <br /> TANK I.D. #(s) ISS <br /> C PERMANENT CLOSURE (Removal or Authorized Closure-in- # TANK(s1_ X $234.00 $ 234.00 <br /> 7Q0( L <br /> 0 CLOSURE FEE _ $78.00/hour (3 hours miniaun/TAN TANK I.D. #(s) <br /> S 7 <br /> U TEMPORARY CLOSURE (Plan Revi eu 8 Inspections) $ <br /> R <br /> E TEMPORARY CLOSURE FEE = f78.00/hour (3 hours minimum/FACILITT) $234.00 minimum <br /> P INSTALLATION PLAN CHECK (Plan Review 8 Construction Inspections) TANK I.D. #(s) <br /> L <br /> mi nisAnVFAL1LIT = S624.00 mininun S <br /> A <br /> N PLAN CHECK FEE = E78.00/hour (8 hours <br /> TANK I.D. #(s) <br /> R REPAIR FEE (Workplan Review 8 Construction Inspections) # TANK(s) __ % E234.00 = E <br /> P TANK LINING REPAIR FEE = $78.00/hour (3 hours miniaAmyTANK) _ $234.00 minimum S <br /> A <br /> 1 TANK RETROFIT REPAIR FEE = 578.00/hour (3 hours min./FACILIT = E234 00 minimum $ <br /> R <br /> PIPING REPAIR FEE _ $78.00/hour (3 hours minimum/FACILITY) <br /> M TRANSFER iEE • E20.00 UNAUTHORIZED RELEASE EVALUATION <br /> $78.00/hr $ <br /> I : $78.00/hr $ <br /> S <br /> C CONSULTATION FEE = 578.00/hr SAMPLING INSPECTION F TOTAL. GlE 6 <br /> ,� -:su�Eos_#"' e�+clrrEa �'' toc CusE ' sr'xan AMGu <br /> EH 23 032 (REVISED 10-28.93) <br />