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...1 •- awn,, vuaUC REAL TN SERVICES <br /> ENVIRONMENTAL HEAL IN DIVISION <br /> UNO ANO STORAGE TANK PROGRAM FEE (A)RKSI!FEI . <br /> FACILITY SITE NAME <br /> A ARCHIE MARSTON, CONSERVATOR FOR MARY FRANSEN FACILITY CONTACT NAME <br /> C ARCHIE MARSTON <br /> I FACILITY ADDRESS 0A14AlILDE <br /> L 7J U SITE PHONE M with AREA CODE <br /> I 9516 <br /> T CITY NONE <br /> Y TOCKTON STATE ZIP CODE N Of TANKS <br /> S <br /> J at SITE im <br /> A APPLICANT/BILLING NAME <br /> r SAME AS FACILITY, ABOVE APPLICANT CONTACT NAME <br /> L <br /> 1 MAILING ADDRESS <br /> C APPLICANT PHONE N WITH AREA CODE <br /> A <br /> H CITY <br /> T STATE 21P CODE TYPE of APPLICATION <br /> CLOSURE, INSTALLATICN, etc. <br /> A <br /> C TOTAL <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) $100.00 1986 1987 1988 1989 1990 <br /> I <br /> V f <br /> E TANK FEE _ %50.00/TANK (prior to January 1, 1991) <br /> 5170/TANK (alter January 1, 1991) <br /> F N Tanks = 1986 1987 1988 <br /> A (TTultlply M by fee for 989 1990 1991 1992 1993 1994 1995 1996 <br /> C each year eppllcab(e) <br /> I f <br /> L STATE SURCHARGE _ $56.00 each TANK (Due every 5 years) See California H S S Code, Section 25287 <br /> T N Tanks_ A $56.00 1986 through 1990 <br /> Y (enter emotnt end year) 1991 through 1996 <br /> C MA <br /> PERNENT CLOSURE (Removal or Authorized Cl,,,e- in-Place) TANK I .D, N(s) U <br /> L CLOSURE FEE 153.00 per hour (7 hours minlm.,n per TANK) N rANK(a)�_ x $159,00 s 318.00 <br /> S <br /> V TEMPORARY CLOSURE (A one-time permit, fcr review/•.,Sm,ions <br /> R ) TANK I.D, p(e) <br /> F TEMPORARY CLOSURE FEE a $150,00 each TANK <br /> TANK(a) _— % $150.00 f <br /> P PLAN CHECK (Ins talc . Olen Review S :onst�•vct•9n �;�pec!;ons) YANK 1.0, p(s) <br /> L <br /> A <br /> N PLAN CHECK FEE . $53.00 per hour (8 hours m n! rer Facility)Y) %424.00 minim, f <br /> R REPAIR FEE (workplan review S crostructim ^s pect�oru) <br /> E TANK I.D. N(s) <br /> P TANK REPAIR FEE _ $53,00 per hour (7 hours minln,,ry TANK) <br /> N TANK(s) _ % $159,00 $ <br /> R PIPING REPAIR FEE _ $53.00 Der hour (3 h;Wr mnl�nm cer r <br /> acyl ity <br /> M TRANSFER FEE - 120.00 'UNA'7HOR',ED RE,EASE FVAL UAiI N $53, <br /> I S <br /> CONSULTATION FEE a $53.00/hr SAMPLING INSPECTION FEE <br /> $53.00/hr f <br /> TOTAL DUE $ 318 M0 <br /> OFFICE USE ONLY 0 <br /> ............ .......... ........ <br /> "tJTS�'U " �w•"gMlta�nN"""�"r�'? ii»iwwilYwdiiU+"wm!j! w: i:,••••.••••i:g <br /> . !'t�. .FI�iWS 95 f E" L'I�JE(f"" <br /> tmm <br /> wa..a+w...rkiw:.5...... e <br /> �w - �X <br /> rwwwww wawwawwrwr sen wrww+wwwraw.rnr w.wa ........ 1e �^I � � _ <br /> m m+ww wwwwwwwnwwaamw q,+o; G7:aweiafA"uiiiiw iiNw wr <br /> 23 032 (REV 4/8/01) it rwwp,erA,w,M,Mw, ,ww.w <br /> Pace <br /> TWO <br />