Laserfiche WebLink
F FACILITY/SITE NAME DERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> A FACILITY W T NAME <br /> 1 pt f4 �-1 �TIOt�; 2Et Y <br /> L STREET ADDRESS <br /> I SITE PHONE 1 (with Area Code) <br /> T Le IJZ O ' <br /> Y CITY <br /> )'jCi STATE ZIP CODE 1 of TANK'S <br /> C�} fa5 <br /> P Cj at Site <br /> APPLICANT/BILLING NAME I l <br /> P �F��� C ti APPLICANT CONTACT <br /> 1 'rbc f4 < � <br /> 1 MAILING ADDRESS <br /> A � fy� �� APPLICANT PHONE f (with Area Code) <br /> NCITY / J1 - ( ' 3%3� <br /> TC?di CJ TL SLATE i1P CODE TYPE-G"PPLICATION <br /> Installation, etc.) <br /> A FACILITY FEE _ $100,00 each SITE ADDRESS per YEAR <br /> TOTAL <br /> T <br /> T 1986 1987 1988 <br /> 1989 <br /> f <br /> V $ <br /> E TANK FEE _ $50.00 each TANK <br /> F 1 Tanks x (50.00 1986 1981 1988 <br /> A (multipiy-i-by fee for 1989 <br /> C each year applicable) <br /> 1 f <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH f SAFETY CODE Sec 25287 for applicability) <br /> I <br /> T 1 Tanks x $56.00 1986 1987 1988 <br /> Y (enter i46unt and year) 1989 <br /> f <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L <br /> 0 CLOSURE FEE = $90,00 each TANK <br /> S 1 Tanks x 190.00 <br /> U - f .'77�, C' v <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two yeas) <br /> E <br /> TEMPORARY CLOSURE FEE = $80.00 each TANK <br /> 1 Tanks z $80.00 f <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> N`PLAN CHECK FEE _ $30,00 each SUBMISSION/RESUBMISSION <br /> f <br /> REPAIR <br /> R <br /> E TANK REPAIR FEE _ $110,00 each TANK 1 Tanks <br /> P _____ z $110.00 f <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 <br /> (when applicable) SAMPLING <br /> INSPECTION <br /> INSPECTION <br /> FEE _ $30.00/hr FEE _ $35.00/hr <br /> FEE = 135.00/hr f <br /> TOTAL DUE $ : 0 , O D <br />' <br /> OFFICE USE ONLY <br /> SWEEPS 1 COMP 1 LOC CODE GIST CODE 1 AMOUNT DUE AMOUNT RCVD CHECK 1/CASH RCVD BY DATE RECEIVED PERMIT 1 <br />