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SAIL .ICAQUIX ` -wrY PISLIC MALTH SERVICES - EXVIRGOIE)CTAL WekLTH OIVSICM <br /> xzZsn STCRAGE TAAK -20G AM - FEE VCIRX <br /> T NAME <br /> S) FACILITY ITE NAME- FACILITY CONTACT` <br /> n <br /> i <br /> E FACILITY ADDRESS SITE PHONE t with AREA CSE <br /> ZIP CSEI a of TANKS 13 <br /> A C.i/fj` I az SITE <br /> P <br /> P APPLI IG }�IWE I APPLICANT CONTACT NAME <br /> L G,L, <br /> I <br /> C MAILING ADDRESS l I APPLICANT PHONE S VITH AREA COOE <br /> A <br /> N <br /> r CITY J v � � STAel ZI I TYPE of AP <br /> CClosurr, Installazian, c.) T/9 /U�\ <br /> G <br /> rare <br /> c <br /> 1986 1987 11988 ` 1989 14913 <br /> ANNUAL FACILITY FEE (Prior .a January t, 1941) = SfOQ.OQ `` <br /> A =a I =c( I S <br /> C <br /> T FACILITY PENALTY FSS ASSESSED (If Apol:able) I r-= I nca <br /> f <br /> v TANK FE: = S50-00/TANK (Prior :axary 1,1991) 5170/TANK (After laixtary 1, 1991) <br /> s ranks 1986 I ;587 11988 11989 1990 11991 1199Z 11993 i 1994 11995 11996 <br /> F (multiply S fee for I I I I I I 1 / 701 <br /> �U I I I S f <br /> A earn year applicable) =(x <br /> C <br /> I TANK PE'IALi'f FEES ASSESSED xxc( <br /> L' <br /> I rATE SURCHARGE = 556.013 --BC-2 TANK Cis every 5 Years) Sr_ California i b S Co-4e, Sec:ian 2:237 <br /> T <br /> T Tanks z 556.00 I :Sm =rough 5990 1991 c.'frough 1996 / <br /> (Enter amount and year) I f Q9-� 54P r— <br /> C$ PERMANENT CLOSURE (Removal or Auzhori-4 =csure-in-Placa) I TANK I.O. :(s) <br /> O) CLOSURE FE. = 578.00/hour (3 hours siniam/TANK) I TANKCs) X 5234.00 s S <br /> S' <br /> U r@4PCRAR7 CLOSURE Celan Review 4 (ttsac^ons) I TANK I.D. '(s) <br /> R <br /> EFr1PCRARy CLOSURE F= = 578.00/hour C: :x�ss ninimrm/FAC:LITY) ( 5Z:4.00 niniusm S <br /> P{ INSTALLATION PLAN CHECX (Plan Review = C-m—CuCtion Insoections), TANK f.D. :(s) <br /> LII <br /> A <br /> N PLAN CiECZ rcc = 578.00/hour CS hours zini—/FACILITY) = S626.013 minimus S <br /> ZI REPAIR FEE (Vorx=(an Review L Gxnt:-=.-:en Inspections) I TANK I.D. 40) <br /> Pj TANK LINING REPAIR FEE s S78.413/hour a `.ours minimu /TANK) I iANK(s) S <br /> A <br /> I TANK ZETRQFIT ZEPAIR rr' = 578-0Q/ttaa' 'S 4orss min./FACILITY) = S234.00 minimum 5 <br /> Z <br /> P(P(NG REPAIR rc_ = S78.OQ/hour (3 hors's ainiman/FACZLITY) = S?34.013 minimum S <br /> M� iRAIJSFcZ = S2Q.OQ I I 1014UirtC21.ZM ZELZ1Sc EVALUATiCH s S78.00/hr I I S <br /> [I <br /> S' <br /> C� CNSULTATION FEE = S78.D13/hr 17 I S%.W—IXG iNSPEC'ION = SM.OQ/hr I I S <br /> TOTAL DUE 5 <br /> -0R OFFTCZ- USE CULT <br /> SUE='�S CGnPUTE.Z t LAC :7E I IIS. CXE I .:401)x7 .2E=ivED CHEF T/GASH I RE—lVp 3y i DAit ZZ—"Eo <br /> .i 73 D32 CRE'/TSE] Paget <br />