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UNI&OUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> ;ACIL1TyxJSITE NAME FACILITY CONTACT NAME <br /> TVA <br /> I SITE PHONE I (with Area Code) <br /> L STREET ADDRESS <br /> T S ATE IIP CODE I of TANK'S <br /> Y CITY ' �5RC) at Site <br /> A APPLICANT/BILLING NAME APPLI ANT CONTACT NAME <br /> P k4 <br /> P 1 N Tb C_ &T AT <br /> L APPLICANT PHONE I (with Area Code) <br /> I MAIL G ADDRESS <br /> C {� `� C1T0 a� � c _ 4 0 C <br /> A STATEJZ CODE ITYPE of APPLICATION j1 <br /> N CITY r -� (Closure Installation et(.) l.Lo''4j <br /> r � . C� Sa n (� ' " <br /> FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR TOTAL <br /> A <br /> C 1986 1987 1998 1989 <br /> f $ <br /> 1 <br /> V <br /> E TANK FEE = $50.00 each TANK <br /> F I Tanksx $50.00 1986 1987 198B 1999 <br /> A (multiply-l_by fee for _ t <br /> C each year applicable) <br /> I <br /> L STATE SURCHARGE _ $56.00 each TANK (see CA HEALTH $ SAFETY CODE Sec 25287 for applicability) <br /> T I Tanks x $56.00 1986 1987 1988 1999 <br /> Tenter aiount and year) $ <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L # <br /> O CLOSURE FEE = $90.00 each TANK I Tanks--1_- x 190.00 U 00 <br /> S. <br /> U <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E I Tanks x $80.00 $ <br /> TEMPORARY CLOSURE FEE = $80.00 each TANK -_ _ <br /> P PLAN CHECK (Installation or Repair) <br /> L _ <br /> A <br /> N PLAN CHECK FEE _ $30.00 each SUBMISSIONIRESUBMISSION <br /> REPAIR <br /> R I Tanks x $110.00 $ <br /> E TANK REPAIR FEE = $110.00 each TANK <br /> P <br /> A <br /> I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> R <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE = $30.001hr FEE = $35.001hr FEE = $35.001hr $ <br /> TOTAL DUE $ <br /> OFFICE USE ONLY <br /> SWEEPS I COMP I LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK I/CASH RCVD BY DATE RECEIVED PERMIT I <br />