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1-09-1997 955AM FROM P. 5 <br /> - SAN JaUlJI' ATT PUBLIC HEALTH SERVICES - ENVIRONMSN <br /> ENTA- .TB DIYISIm <br /> t .RC2WND STORAGE TANK PROORAX - FEE WOREM <br /> `i <br /> S FACILITY SITE FACILITY CONTACT NAME <br /> T c6R S fZE "$ © 1x05 HcA 1 rAI LH <br /> E FACILITY ADDRESS AVE <br /> SITE POWE 3 with AREA CODE <br /> i t <br /> STATE ZIP CODE 0 of TANGS <br /> A C��ATH _jt)f> C 9 53 ai SITE <br /> P APPLIGNT/SILLING NAME THE GIR.LLe K CDrVIPAwJy 71ICANT CONTACT NAI¢ <br /> ti4 L�1viSt DF T %C) �aTt1�FZ N� Sv <br /> C MAILING ADDRESS APPLICANT PNONE f WITH AREA CODE <br /> N ("a01 UNION ST. STD-C) L-t Li g---7 S 7 <br /> T CITY STATR uCMv CTYPE Of APPLICATIONf-�EPAIlZ <br /> .S tt4 TTI-e til ICI (Closure, Installation, etc.) <br /> TWAL <br /> 1986 1987 1988 11989 11990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) a 5100.00 <br /> A xxxx I xzxx xxxx xzxx xxxx S xxxxxxxXXXXXX <br /> C <br /> T FACILITY PENALTY FEES ASSESSED (if AppLieable) xxxx xzxx xxxx xxx% xxxx 5 YXxXxXx%xX%X% <br /> I <br /> V TANK FEE = 550.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E <br /> I Tanks = 1986 1987 1 1988 1 1989 11990 1991 11992 1993 11996 11995 1996 <br /> F (m,(LipLy # by fee for <br /> A each year applicable) xxxx xxxx xxxx xxxx Kxxx I $ <br /> C <br /> I TANK PENALTY FEES ASSESSEDI Xxxx I xzxx xzxx xzxx I xzxx I S <br /> LI <br /> I STATE SURCHARGE . S56.00 each TANK (Due every 5 years) See California H i S Code, Section 25287 <br /> T <br /> Y a Tanks x 356.00 1988 through 1990 1991 through 1996 <br /> (Enter amount and year) <br /> S ' <br /> C PERMANENT CLOSURE (RemovaL or Authorized Closure-in-Place) I TANK 1.0. Y(s) <br /> L <br /> O CLOSURE FEE = 578,00/hour (3 hours minimax/TANK) I 0 TANK(S)— X 5234,00 = S <br /> 5 <br /> U TEMPORARY CLOSURE (Plan Review i Inspections) TANK 1_0. ti(S) <br /> Y <br /> E TEMPORARY CLOSURE FEE a 578.00/hour (3 hours minimum/FACILITY) 5234.00 minimum i <br /> P INSTALLATION PLAN CHECK (Plan Review i Construction inspettions) TANK I.D. !(s) <br /> L <br /> A <br /> N PLAN CHECK FEE = 378-00/hour (8 hours minis n/FACILITY) = $624.00 minimum <br /> R REPAIR FEE (Workplan Review i Consirucil on Inspections) I TANK I.D. N(S) <br /> E <br /> P TANK LINING REPAIR FEE = 578.00/hour (3 hours minimum/TANK) s TANK(s) X 5234.00 a S <br /> A T' <br /> 1 TANK RETROFIT REPAIR FE`_ = 378.00/hour (3 hours min./FACILITY) = 3234.00 minims S <br /> R <br /> PIPING REPAIR FEE = 578.00/hour 6 hours minimum/FACILITY) = 5234.00 mini nam S� <br /> M TRANSFER FEE = 320.00 I UNAUTHORIZED RELEASE EVALUATION a 578.00/hr i S -- <br /> I <br /> 5 � <br /> C CONSULTATION FEE a S7E.OD/hr I SAMPLING INSPECTION FEE • 578.00/hr I `+ <br /> TOTAL DUE s ? .00 <br /> FOR OFFICE USE CULTRONRSR <br /> mieiryJLLM INa oua — YIIII tl _ - _-�ERC9 31Ra®I� YX311 IRI113111 ! <br /> SWEEPS x I COMPUTER tr LOC CODE I DIST CODE I AMOUNT RECEIVED I CHECK X/CASH I RECEIVED BT I DATE RECEIVED <br /> Mm' e Is- <br /> -_ _ .. 9�. ;_ .. <br />