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i <br /> I •- <br /> VAg TANK 1lOGRAN FEE T —:i <br /> -- - --... <br /> FACILIT TACT NANE463 �lOg <br /> JIM IbBLITZELL <br /> ---- SITE rM ( mo ..RL. COOK — <br /> tEET — �QE 1 of Tants (4) <br /> + ` SIAL it Site <br /> FO`.-_-._ <br /> CA <br /> ---- APPLICANT CONTACT NAME ENGINEER <br /> PATRICK I1>lal, <br /> PLANT..........._...._................_—._._._. NITN ARL^1'COOL <br /> - APPLICANT PHONE 1(n) `4g 5800 <br /> TYPE of APPLICATION REMOvAL/CLOSU E <br /> T$ fjTE 'L TYPE of IPLICATIO 10M. [T0. <br /> _—.. _ <br /> .,......__..__.._...........__........_......__ TOTAL <br /> VEAF <br /> \; 1381 1980 i389 <br /> \ - <br /> E TANK FEE - .- - 1383 <br /> ,....,. _.. 1988 <br /> --- 1987 <br /> F 1 Tanks x T50,00 -_ <br /> _ 5 <br /> A (Lultipfy f by lee for <br /> C each year applicable) <br /> -------- ---- <br /> L STATE SURCHARGE - 456.00 each TANY. (see CA HEALTH 6 SAFETY CODE Sec 2528) for applicability) <br /> 1 ..._,..__........__ 1981 1 119E 1383 <br /> T I Tank,s____, <br /> Y amoun <br /> x 4 6.011 1386 1I <br /> (enter t and year) -' <br /> 5 <br /> Lr <br /> PEPMANENT CLOSURE (Removal or ciosure rn pIa.e) <br /> . <br /> 60.00 <br /> 0 CLOSURE FEE 430,00 each TANK I I Tants_ __• x 590.00 4 <br /> U .... .....- <br /> R TEMPORARY CLOSURE (Only allowed one time (or up to two years) _ <br /> Tanks x t80,00 4 <br /> TEMPORARY CLOSURE FEE - $80.00 each TANI: <br /> . .... ._.._. <br /> P PLAN CHECK (installation or Repair) <br /> L..._-.......... .._...........................•...........,-_...............-.-_.._.--...__.__".. ._,.. .-._..-_.... ...................__.. _........ --- <br /> II PLAN CHECK FEE = 430,00 each SUBMISSION/RESUBMISSION 4 <br /> ...... _ _.. ..... ........ -- <br /> REPAIR <br /> - -- ._ .. ...-.... .................. .. _ <br /> P. TANK. REPAIR FEE 1110.00 each TANK 1 Tanks _ _ x 5110.00 <br /> P _ _ _ <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (when applicable) (when applicable) (when applicable) <br /> FEE 130 O 1.p/hr FEE_ 135,00/hr FEE 435,00/hr f <br /> TOTAL DUE s <br /> OFFZCI USE ONLY <br /> A! V 1171QQIA09QQ9QMI��fllll�ll, IQIIQQI1QQQtlIIflIIIIBIIIINNQQQIIVtlIIIItlBQIISQQ96111111000QQIIQQIIQIIIIIIIQIQ91@IIIIQQQQIIIQIII@IQQI�QNQQBIIVQNQ�IVIIGQIIQIIQIIGI�.IQNO�IINIQI�QIIQI� IIQ IIV9MINtlQGIIINGQ�IIBQ I�I�ISI <br /> SWEEPS I COMP I LOC CODE DIST CODE AMOUNT OUE AMOUIIT RC,VD CHECK I/CASH RCVD BY DATE RECEIVED PERMIT <br /> i <br /> p1l '"AllR1111v' �'�I IIIYIV�I�� lu .IIIQUIItlII�QIIIII IuaQIIQIIQIIIIQQQI�oILUIIIIIIQI�QQIIUII�uQIP!IILQIIQQGIQUIIIQI41ImIIluIQQUQII IIIImIIIIirIIEI�IIIIIQIIIIIIIQQQIn flAAIIQUIIIUIIflINIIVflll��1�WI�uiIflINIUV�o <br /> i � <br />