Laserfiche WebLink
SAN #QUI N LOCAL HEALTH D I IO I CT r, <br />UtiOERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br />F <br />FACILITY/SITE NAME <br />FACILITY CONTACT NAME <br />0 <br />S <br />TOTAL <br />A .._. <br />L <br />T— <br />STREET ADDRESS 1� E <br />{J <br />SITE PHONE 1 arra "RA Goma <br />Y <br />CITY' <br />STAT <br />IP CODE <br />B of Tanks <br />1 Tanks x $80.00 is <br />^c== ,J <br />I <br />at Site <br />A <br />APPLICANT/BILLING NAME <br />APPLICANT/ CONTACT NAME <br />L <br />L <br />b S E ✓/C <br />1MAILING <br />( <br />ADDRESS n <br />APPLICANT PHONE 1 x11" MUA Game <br />F 1 Tanks — x 150.00 <br />N <br />T <br />CITY <br />K7a <br />1988 <br />C�/ <br />PLICATION <br />RITa PLICATION aeG. <br />A (0ultipTy_ 1_ by lee for <br />-- <br />FACILITY FEE • 1100.00 each SITE ADDRESS per YEAR <br />PERMANENT CLOSURE (Removal or Closure -in-place) <br />----=------ —> <br />— <br />0 <br />S <br />TOTAL <br />A .._. <br />is <br />_ <br />-- <br />1986 <br />1987 <br />1988 <br />1989 <br />T <br />1 Tanks x $80.00 is <br />i <br />I <br />{ " <br />{ <br />V <br />E TANK FEE • 150.00 each TANK <br />F 1 Tanks — x 150.00 <br />1986 <br />1987 <br />1988 <br />1989 <br />A (0ultipTy_ 1_ by lee for <br />-- <br />{ <br />C each year applicable) <br />1 -- — <br />L STATE SURCHARGE • $56.00 each TANK (see CA HEALTH <br />1 SAFETY CODE Sec 25287 <br />for applicability) <br />T 1 Tanks x 156.00 <br />1986 <br />1987 <br />1988 <br />1989 <br />Y (enter iiiiit and year) <br />C <br />L <br />PERMANENT CLOSURE (Removal or Closure -in-place) <br />----=------ —> <br />— <br />0 <br />S <br />CLOSURE FEE • 190.00 each TANK <br />-- ' — <br />1 Tanks_- __ x 190.00 <br />is <br />U— <br />-- <br />R <br />E <br />TEMPORARY CLOSURE (Only allowed one time for up to two years) <br />-- -- — <br />per hour, minimum one hour to be paid on plan submittal) <br />TEMPORARY CLOSURE FEE = 180.00 each TANK <br />1 Tanks x $80.00 is <br />i <br />P PLAN CHECK (Installation or Repair) <br />L— — --- <br />— <br />R TANK REPAIR FEE • $110.00 each TANK <br />A <br />1 Tanks s $110.00 <br />It PLAN CHECK FEE • 130.00 each SUBMISSION/RESUBMISSION <br />f <br />REPAIR <br />R TANK REPAIR FEE • $110.00 each TANK <br />1 Tanks s $110.00 <br />1 <br />E <br />p <br />-- <br />_--- <br />A PIPING REPAIR/CLOSURE/REMOVAL (Fees are <br />per hour, minimum one hour to be paid on plan submittal) <br />R UNAUTHORIZED RELEASE EVALUATION <br />When applicable) <br />FEE • $30.00/hr� <br />CONSTRUCTION INSPECTION SAMPLING INSPECTION <br />(when applicable) When applicable) <br />FEE = f35.00/hr FEE • $35.00/hr <br />i <br />TOTAL DUE <br />{ " <br />OFFICE OSE OILY <br />