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• w Nc,nwulrw LuI:HL N�r1L'IN U1F <br /> EROROUNB <br /> F rACIC11Y15f1E NAME 9fORAOE TANK PROORAR - FEE 11ORKS11l 1 <br /> hrAC II,I TY CONTACT NAME <br /> S'Jc o r��'�,,�� <br /> L STREETS D REZ <br /> SITE PIIOHE I with Area Code) <br /> Y CITY <br /> !cj* ti y� STAT ZIP CODE I of TANK'S <br /> A APPLICANT/PILLING NAME •� ak 5ike ���� <br /> P APPLICANT CONTACT RARE �- <br /> i MAILING AgRESS v +� <br /> N CI1 �, APPLICANT Pilo E 1 (vith Area Code) <br /> _ � <br /> T r� l <br /> 7C�CF� �V S 1 �P CODE TYPE of APPLICATION <br /> i7,s (Closures Installations et(.) <br /> A FAC1LI1y FEE = 1100.00 each SITE ADDRESS per YEAR <br /> C <br /> 1 1906 1961TOTAL <br /> I ���� l48B 1489 <br /> E TANK FEE = 150.00 each TANK ! <br /> F 1 Tanks x 150.00 <br /> A fmullipTi-l-by fee for 1906 1991 1988 <br /> C eac�applicable) 1481 <br /> L STATE SURCHARGE _ {56.00 each TANK, (see CA HEALTH k SAFETY CODE Sec 25281 for a 1 <br /> I <br /> r I tanks x 156.00 ppllcab111ty) <br /> Y (enter mount Ind year) 1406 1981 l4O8 <br /> C PMANLNT CLOSURE (Rpmoval or Closure-In-place) t <br /> L <br /> 0 CLOSURE FEE 2 130.00 each TANK <br /> 5 <br /> U I tanks x 140.00 <br /> R TEMPORARY CLOS <br /> E URE (Only allowed one time !or up to wo years) 1 <br /> TEMPORARY CLIISURE FEE e {00,00 each TANK <br /> 1 tanks-- r 104.44 <br /> PLAN CHECK <br /> L Ilnstlllation or Repair) 1 <br /> L <br /> A <br /> H PLAN CIIECK FEE 130,00 each SUOMISSION/RESUBMISSION <br /> REPAIR <br /> R <br /> E fANK REPAIR FEE 1110.00 each TANK <br /> P <br /> A I SURE/R[KOVAL (Fees Are Tanks— <br /> I <br /> x 1II4.40 <br /> I PIPING RCPAIR/CLOe per hourr, minimum ane 1 <br /> R _ <br /> U1(AUiFiBRIdEO RELEASE EVALUATION hour to be paid an plan subm[ttal} <br /> (when applicable) CONSTRUCTION <br /> —�— INSPECTION ] SAMPLING <br /> TEE 2 130,00/hr INSPECTION <br /> FEE = 135.00/h► <br /> FEE z 135.00/hr <br /> t <br /> dFllCf USE 4RfY TOTAL CUE 1 <br /> 51fEffS f COIY y LDC CODE DIST CODE AMOUI(T DUE AMOUNT RCVD <br /> 7�7,a( ��� �� 3 ;—�..,_ 4o�� CHECK TlC1S11 RCyO 8Y DATE RECEIVED PERMIT f <br />