Laserfiche WebLink
y plv JLI LU ... <br /> UNIi7UMD STORAGE TANK PROGRAM FEE WORKSHEET - <br /> FACILITY CONTACWME <br /> FACILITYISITE NAME p e r <br /> A T `5 rll7 es <br /> C SITE PHONE "RIA COdd <br /> I <br /> L STREET ADDRESS <br /> I CEJ / <br /> Y 1 0l Tanks <br /> r Sjp� 11P CODE <br /> o6 at Site <br /> CITY C�VG-t0 CCS -- --_- <br /> v APPLICANT CONTACT/�NAMEl� <br /> A APPLICANT/BILL(N6 NAME I VI R V k �✓ 1-` r f' <br /> P �� -- -- APPLICANT PHONE 1 MIT" A'ee CODE <br /> MAILING ADDRESS _ aoS - S' I ' Sz'�d — <br /> eC <br /> ql �- �- r S pr 11P CODE TYPE of APPLICATION IU CAt e <br /> � CLOS WEr INITALLATIDNr [TC.--t <br /> H clTr <br /> T D n ----- - - —� 'TOTAL _ <br /> FACILITY FEE Z--$100-00 each SITE ADDRESS per YEAR ` _--- - -1503 <br /> A -- 1986 1987 1998 - <br /> C <br /> V ----... <br /> E TANK FEE _ $50,00 each TANK _ - 1988 1983 _---- <br /> 1986 1307 ��o <br /> F 1 Tanks : 150.00 --- t <br /> A OultipTy E'by lee for -- <br /> C each year applicable) <br /> I <br /> L STATE SURCHARGE 1 $56.00 each TANK (see CA HEALTH 1 SAFETY CODE Sec 25287 for <br /> 1903applicability) <br /> -_ <br /> 1 - 1386 1987 1988 - o - <br /> T 1 Tanks___`- x (56.00 -- f <br /> Y (enter as o nt and year) <br /> C PERMANENT CLOSURE (Regoval or Closure-in-place) _------ - 1 <br /> L 1 Tanks_ %,130.00 <br /> CLOSURE FEE _ %90.00 each TANK - <br /> U _ - <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) x 180 00 $ <br /> E - 1 Tanks_ -- <br /> TEMPORARY CLOSURE FEE _ $80.00 each TANK -_ <br /> P PLAN CHECK (Installation or Repair) - -------- - <br /> L f <br /> A - --- <br /> 11 PLAN CHECK FEE 1 $30.00 each SUBMISSIONIRESUBMISSION ---- --_ <br /> REPAIRI Tanks x 11(0.00 <br /> R TANK REPAIR FEE : 1110,00 each TANK R — :� _.1__ -._-- ----- <br /> E �- o be paid on plan submittal) <br /> P - minimum oqw _ <br /> APIPING REPAIR/CLOSURE/REMOVAL (Fees are per gbUr,- tC SAMPLING 1115PECTION <br /> I (vhen applicable) <br /> R UNAUTHORIIED RELEASE EVALUATION CONSTRUCT A M __._.-___--.....-..-. <br /> (when applicable) (when -._ $ <br /> _ FEE - <br /> FEE _ <br /> FEE = s35.00/hr <br /> $30.00Ihr T <br /> _ --_-•- 1 _ -- .-.- ----- TOTAL DUE <br /> OFFICE USE ONIK a 9�iu ��1w�T , �.� IduGn�l91 � I��l� ti@°ti�A J <br /> — --- - <br /> i <br /> SNEEPS 1 COMP $ LOC CODE DIST CODE AMOUIIT DUE <br /> AMOUNT R� CHECK 1/CASH RCVD DY GATE RECEIVED PEP.M <br /> i <br />