Laserfiche WebLink
L. rI GNL I ria PC LI. I <br /> yyUNDERGROUND STORAGE TANK PROGRAM - FEE WORKS ET <br /> • iF FACILITY/SITE NAME FACILITY CONTACT NAME <br /> IIA <br /> C <br /> I <br /> L STREET ADDRESS SITE PHONE I (with Area Code) <br /> T a 'r T <br /> Y CITY40 STATE LIP CODE t of TANK'S <br /> at Site <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE I (with Area Code) <br /> C <br /> A <br /> N CITY STATE 71P CODE • TYPE of APPLICATION <br /> I (Closure, Installation, etc.) <br /> A FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR TOTAL <br /> C 1986 1987 1988 1989 <br /> ot1 /R /✓ # <br /> V <br /> E TANK FEE = $50.00 each TANK <br /> F 1 Tanks x $50.00 1986 1987 1988 1989 <br /> A (multipTy f-by fee for <br /> C each year applicable) <br /> L STATE SURCHARGE = $56.00 each TANK. (see CA HEALTH f SAFETY CODE Sec 25287 for applicability) <br /> I <br /> T t Tanks x $56.00 1906 1981 1908 1989 <br /> Y (enter zuount and year) <br /> f <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L <br /> 0 CLOSURE FEE = $90.00 each TANK I Tanks x (90.00 $ <br /> S - <br /> U <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E <br /> TEMPORARY CLOSURE FEE = $80.00 each TANK 1 Tanks x $00.00 f <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> N PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION $ <br /> R REPAIR <br /> E <br /> P TANK REPAIR FEE _ $110.00 each TANK 1 Tanks x $110.00 $ <br /> - <br /> A <br /> I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to he paid on plan submittal) <br /> R <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION i .. SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE = $30,00/hr FEE = 1135.00/hr FEE = 1135.00/hr $ <br /> TOTAL DUE <br /> OFFICE USE ONLY <br /> SWEEPS 1 COMP I LOC CODE DIST CODE I AMOUNT DUE AMOUNT RCVD CH CK /CASH RCVO BY DATE RECEIVED=PERMITI <br /> 1 !�ilV�lilp o� 3ad ' ISS /S7�° 3�2 8 �7 <br />