Laserfiche WebLink
uNuLX690UN0 STORAGE TANK PROGRAM - FEE VORKSHEET <br /> JFAC(LITY/SIiE NAME TSITE <br /> CONTAC riE <br /> A � � �I:�V� -�k�f 5 M A►��T <br /> L STREET ADDRESS NE I (with Area C;,de) <br /> .1 1111-1 �. t4 i v !"LO <br /> T <br /> Y CI1Y�li'�I �STATE ZIP CODE uSit�NK's <br /> at � <br /> C- � <br /> A APPLICANTIBILLING NAME f <br /> lid©i� JIV t� r APPLICANT <br /> ©A f�11TA'300,eG <br /> ME <br /> L `J <br /> I MAILING ADDRESS APPLICANT PHONE I faith Area Code)pot 19 9-0 <br /> CITY <br /> 1 STATE ZIP CODE TYPE of APPLICATION <br /> T ���'�� � 275 GLoscJ1�'-� <br /> Cf1• (CIi,sure, Installation, etc,) <br /> A <br /> FACILITY FEE = $100.00 each SITE ADDRESS per YEAR <br /> TOTAL <br /> T 1986 I'387 1388 1989 <br /> T <br /> I <br /> V $ <br /> E TANK FEE _ $50.00 each TANK <br /> F I Tanks _ r $50.00 1985 1937 1 89 <br /> A (aultipty l-by fee for 1'33'3 <br /> C each year applicable) <br /> I $ <br /> L STATE SURCHAhE z $55.00 each TANK (see CA HEALTH & SAFETY CODE Set 5281 for applicability) <br /> I <br /> 1 I Tanks x $56,00 1985 1981 1988 <br /> Y (enter a,Kk and year) 1989 <br /> C PERMANENT CLOSURE keaoval or Closure-in-place) <br /> L <br /> O CLOSURE FEE _ $90.00 each TANK_ anks- <br /> I T _✓ x $90.00 $ 7©, 0 <br /> u <br /> E --- <br /> 8 TEMPORARY CLOSURE (Only allowed one tine for up to tva years) <br /> TEMPORARY CLOSURE FEE = $30.00 each TANK <br /> I Tanks x $90,00 j - - <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A � <br /> N PLAN CHECK FEE = $30,00 each SUBMISSION/RESUBMISSION <br /> REPAIR <br /> R <br /> E TANK REPAIR FEE _ $110.00 each TANK <br /> P I ranks x $110.00 <br /> A Tanks__,__ <br /> I PIPING REPAIRICLOSURE/REMOVAL (Fees are per hour, ainirui one hour to be paid on plan subaittal) <br /> R <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION <br /> (when applicable) INSPECTION SAMPLING <br /> INSPECiII]t( <br /> FEE = $04.00lhr FEE = $35.00/hr <br /> FEE <br /> TOTAL DUE $ 70, <br /> OFFICE IlSE <br /> ak'4 <br /> SWEEPS I CORP I LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK 11CASH RCVO BY DATE RECEIVED PERMIT I ■M <br /> x .., r �hR �,. iLYIrT'�1'��?"'s�^,��•c��,1�r^/��r��l.',4/ <br /> .'tr S: rr�,..r' t-�,L.•t -tNn: �S.U..;.i:..ryx t]. tfS' �4 t i- 6-� m-q•� <br />