Laserfiche WebLink
ie� 1e i�.n� a+o -syr'YIrYnFga 4.YP11 rW li1. n<}ai:n aGat.ypS - gt�FVallrJt lAl IIiLFLIF Yl Y.f 14.t1`Vyr a__r�i •i <br /> UNMR01)ND STORM TARK PROGRAM - FEE {KRKS1IEET_ <br /> S FACILITY SITE NAME �--�— FACIL4 [0 T NAME <br /> T _._..__� �`� <br /> E FACILITY ADDRESS SITE PHONE f with AREA CODE <br /> CITY / //•;�, STATE ZIP CODE # of TANKS <br /> pC. T/Cut. (�1,/- `^_5-0ZS�at SITE <br /> P APPLICANT/BILLING XAME / APPLICANT Ctl ACT <br /> lIJ4`><irr �J'�n rP (�ic.ZA <br /> C RAILING ADDRESS APPLICAN PHONE # uITN ARFJI CODE <br /> T CITY ST/yT ZIP CODE ]CATION <br /> CtoAure taltatian, etc.) <br /> TOTAL <br /> 1986 1987 Y988 1989 <br /> ANNUAL FACILITY FEE (Friar to Janary 1, 1991) = 5100.00 1990 <br /> A xxXx xm xxxx )OXXX S <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (If Appllcahte) xxxx xxxx I xxxx xxxx S <br /> I <br /> V TANK FEE a S50.00JTARK (Prior to lalxary 1,19911 5170/TANK (After January 1, 1991) <br /> 8 <br /> Al Tank$ 4 1986 1987 1988 1989 1990 1991 1492 1993 1994 1995 1996 <br /> F (muttiply M byby fee for <br /> A each year applicable) xxxx lI xxxx xxxx xxxX 5 <br /> C _ <br /> I TANK PENALTY FEES ASSESSED xXx% xXXY 7000( XXXx 5 <br /> L <br /> T STATE SURCHARGE =. 556.00 earls TANK (Due every 5 yearc) See California x & 5 Cade, Section 75287 D2.3.7 <br /> Y # Tanks 9- x 556.00 1988 through 1990 1991 through 1996 <br /> (Enter amount and year) <br /> Ile . 112 . 60 <br /> C PERMANENT CLOSURE (Removal or Authorized CLosure-in-Place) TANK [.O. #(a) <br /> 0 CLOSURE FEE = 578.00/hour (3 hours minimum/TANK) # TANK(s) &_ X $734.00 Q E y CSO <br /> S <br /> U TEMPORARY CLOSURE (P(an Review & Inspections) TANK [.0. #(S7 <br /> R <br /> E TEMPORARY CLOSURE FEE = S78.00/hour (3 hCUrs mintAlWFACILITT) 5234.00 minimlml 5 <br /> P INSTALLATION PLAN CKECK (Plan Review & Construction Inspections) TANK I.D. #(s) <br /> L <br /> A <br /> R PLAN CNECX FEE _ $78.00/hour (8 hours minimn/FACILITY) $624.00 minima S <br /> R REPAIR FEE (Workplan Review & Construction Inspections) TANK I.D. #(s) <br /> E <br /> P TANK LINING REPAIR FEE = 878.00/hour (3 hours minlmlm/TANK) # TAMK(s) x 5434.00 = S <br /> A <br /> 1 TANK RETROFIT REPAIR FEE = ST8.03/heur (3 hours min./FACILITY) = SM.CO min(RAm E <br /> R <br /> PIPING REPAIR FEE = 578.00/hour (3 hours minia"FACILITY) a $234.00 minimum 5 <br /> M TRANSFER FEE a S20.p0 UNAUTHORIZED RELEASE EVALUATION - S78. Ar. S <br /> 1 <br /> 5 _ <br /> C CCN <br /> SAMPLING INSPECTION FEE &73.0(1/hrSULTATICM FEE:, 179.00/hr f <br /> TOTAL DUE $ <br /> FOR OFFICE USE ONLY <br /> a---tea= ----.— .I V ED M•:IX 01 'iiwaiimm.5wtii WE==S-dim` <br /> SWEEPS # I COMPUTER # I LOC CCpE DIST CODE AMOUNT RECEIVED CNECC #/CASH RECEIVED BY OATS RECEIVED <br /> xmsatxm mtnstma ��' <br /> EH 23 032 (RE'/ISED 4-6-95) <br />