BILLING - Laserfiche WebLink

Home Browse Search

8AN _TOAQU I N LOCAL HEALTH DI R ICT OERGROUND STORAGE TANK PROGRAM - FEE 0RKSHE, F FACILITY/SITE NAME FACILITY CONTACT NAME A qjq, M 01�t e I �--_ SITE PHONE #�'� AREA coop r ` L STREET ADDRESS Y CI � STA�TE — P ZIP CODE t of Tanks Y CITY at Site A APPLICANT/BILLING NAME APPLICANT CONTACT NAME _� r W f ^--.� �__ ._ _ _ L APPLICANT PHONE # WITH AREA coot I MAILING ADDRESS N CITY r G glT 21P CODE APPLICATION T / C60$WRE, Ii19TALLATION, ITC.4444�U —r — TOTAL FACILITY FEE = $100.00 each SITE ADDRESS per YEAR A � C — 1986 1987 1988 1989 _ _ 1 � V E TANK FEE _ $50.00 each TANK F t Tanks �•'x $50,40 __---. �._. 1996.µ— -- 1987 -_ 1988 1989 T— A (multiply i by fee for —r— C each year applicable) J Q r 6o Q L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH $ SAFETY CODE Sec 25287 for applicability) I T I Tanks x $56.00 —1486 1987 1988 1989 _ -- Y tenter ahovnt and year) 6 4, C PERMANENT CLOSURE (Removal or Closure-in-place) — L I Tanks 1 x $90.00 $ q D CLOSURE FEE = $90.00 each TANK ___ U. _ -- _ P, TEMPORARY CLOSURE (Only allowed one tine for up to two years) E I Tanks x $80.00 $ TEMPORARY CLOSURE FEE = $80.00 each TANK —— P PLAN CHECK (Installation or Repair) A $ N PLAN CHECK FEE = $30.00 each SUBMISSIONlRESUBMISSION REPAIR R TANK REPAIR FEE = $110.00 each TANK t Tanks x $110.00 $ A PIPING REPAIRICLOSUREIREMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION (when applicable) (when applicable) (when applicable) FEE = $30.001hr �— FEES $35.00lhT FEE _ $35.04/hr� $ j �o TOTAL DUE $ OFFICE USE ONLY r' �•G ' 13 5 1'�nwl 11wEMM 1q f111��@IEI�II 1i� lel 1�1V11� I lIU� 1 lll�ll(��11'�lQlll�lli�11111 3111�llNallSWEEPS I COMP I LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK IICASH RCVD BY DATE RECEIVED PERMIT I }�°� �a�11 �� ill��l ll l�lm1�111�1 u�l l l u1 I ��Ilm l��l i11�111� �Imllulnl� ulll�l�l1a1n11l nu 1� 11 11 1�1I��1 i11 nll�li � I� it �i,