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FROM 06/08/89 14 : 54 P . 2.. .. . .... ,
<br /> 11ERGROUMO STORAGE TANK PROGRAM - FEE MORKSA
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<br /> Y aTRE T B SS ...� .�[� A. - IP CODE EVPa of TanksNcf_P7eC7
<br /> 1 n AIM4 RECEIVED
<br /> I}E'CEI V
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<br /> A APPL Ni/BI NG NAM APP I NT CO CT NAMEFNVIRONMENTAL HEA
<br /> p Iv1 -., Lr PERMIT/SERVICES
<br /> tM AOAPFSb ��l! O I MITN ARIe coos
<br /> A
<br /> ___�..... .... __....___..__.... T o PLICATION
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<br /> N CIT P O
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<br /> T �` ILS ` '� LoaUAE NETALLATION. Ere.
<br /> FACILITY FEE = 4100. w. .....n__......._......_
<br /> 00 each ITE ADDRESS per YEAR TOTAL
<br /> A _... _._ _- _.. _.....,.. __..-------
<br /> .
<br /> 1986^ M1981 19AA� 1983 �� —
<br /> r - _ F._._
<br /> I 1
<br /> E TANK FEE - 550.00 each TANK
<br /> _.. .. ,. ,.--. ._....................
<br /> F I tanks z 150.00 i9A6 198 1988 1389
<br /> A (multiply I-by fee for _, .._. .._._...,.._,
<br /> C each year applicable) f
<br /> 1 _.n_.._._„__..____..... _._ _. .--.- --- . ..._..___._.w. .w_. .___...._
<br /> L STATE SURCHARGE = 556.00 each TANK (see CA HEALTH 6 SAFETY CODE Sec 25207 for app I t )
<br /> T a Tanks % 156,00 1986 1987 19BA 1 1383
<br /> Y (enter amount and year)
<br /> .............. ,,.,,,...,....,..... _ __...............,,..,_..,..---_ __. __.._._.._ww..s -- -_
<br /> r ”"n._
<br /> PERMANENT CLOSURE (Removal er„Closure-in place)
<br /> _ _.
<br /> 0 CLOSURE FEE_ 4190,00 each TANK i#� I Tanks i.... %
<br /> -- - -.._........__.._.. -.
<br /> U ,_.............---...............,.,,..w_ n.,.._,.n_.._.-------__,w_._......._ ,,n_._-....._w... -_-_n--_•_-_._---_.-__
<br /> F, TEMPORARY CLOSURE FEE - -SB0.00 each TANK :_.._.._ �..,+ w -n. �W..._00 V m m w
<br /> .. .......
<br /> Tanks z (80.00
<br /> f
<br /> E TEMFORAP,Y. C�CLOSURE a_n-ove-one_time or uptooy,tva years)_ .,_.,.,-......._...,__.-..,_-,.--•'V__.___..— _
<br /> A LAN CHECK (Installation or.Repair•)•__ ...._,..._..................----.___.,._........._._---._... ,_w...,_..___.___— __.___n _ .w_,
<br /> N PLAN CHECK FEE = 130.00 each SUBRISSION/RESUBMISSION 4
<br /> _,_..._.................._..........._._..,..._..._,..,...-._.....n.....,,,-,.,_......._ .__..__.,,,,._. ._...._......,,.,.,.w..........,..__
<br /> REPAIR (
<br /> R TANK REPAIR FEE , ....................... __ ......._........ _.,.- . ......__._....,.w .. ........._..1.1...T' ks...- _.z..f110,00.,,,..._ w,,,,.,s.,._._.�._
<br /> 0.00 each TANK
<br /> P....... REPAIR/CLOSURE/REMOVAL ---.-__...
<br /> A PIPING (Fees are per hour, minimum one hour to be paid on plan submittal)
<br /> R u NAUTNORITEtl REL EA5E EVALU-ATION-_-.�CONSTRUp1E0N ble) ----•__,__.._, ...__....___..,..,._,,,_n.,..,._�__._..r,_.-.____,....,._...�_...�w.,
<br /> INSPECTION SAMPLING INSPECTION
<br /> hen applicable) (when a plica When applicable)
<br /> FEE = 130.00/hr ....__........,. _... ,...._.... .FEE = %35.00/hr FEE = $35.00/hr
<br /> TOTAL DUE
<br /> OFFICE USE ONLY
<br /> „� E I F� >a�au�.nppl�0�uC�nRnByaMCn�nOI�uD�fE R19 11 Z�IP
<br /> � i""'M
<br /> me"m DIST CODE AMOUNT UE AMOUNT RC CHECK CASH RCVD BY mBATT
<br /> �r�RECEIVED PE�RAMI.
<br /> T !
<br /> lip 101�n
<br /> MUMS�r mir �
<br /> TOTAL P . 2
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