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Aug. 13. 7007 9: 12AM Ad,"gcecl CeoEnv 'i ronmental No, 9447 P. 10 <br /> 16ROURD STORW TANK PROGRAM EEE VORKSHE <br /> FACII.IITlS1TE NAME � FACILITY CONTACT WE <br /> C if <br /> L STREET ADDRESS SITE PHONE K �zsN ,pec• case <br /> Y CITY STAT IlP CODE It of Tanks f <br /> � ''rCC7•.� ak 5ite 1 <br /> A APPLICANTIBILLING NAME: APPLICANT CONTACT HANE <br /> P <br /> q Co Me I- <br /> L kgN <br /> 1 NAILING ADDRESSAPPLICANT PHONE 1 Wrrm AICA Cane <br /> ti <br /> H CITY AT ZIP COD£ APPLICATION <br /> r� e y CLg6Ul1 C, INOTALLM IOM, CTC. <br /> rACIL1TY FEE ■ 1100.00 each SITE ADDRESS per YEAR IOTAI, <br /> C 1986 19117 1969 1989 <br /> r <br /> 1 1 <br /> v <br /> f TANK FEE = $10.00 each TANK <br /> F 1 Tanks2 150,00 1986 1981 1989 1989 <br /> A (RultgTj _by fee for <br /> C each Year applicable) 1 <br /> I <br /> L STA1> SURCHARGE z $56.40 each TANK (see CA HEALTH 4 SAFETY CODE Sec 25281 for applicability) <br /> T 1 Tanks a $56.00 1985 1987 1488 1989 <br /> Y (enter wiiount and year) — <br /> 1 <br /> C PERMANENT CLOSURE (Removal or Closure—in-place) <br /> L — — <br /> 0 CLOSURE FEE $50.00 each TANK 1 Tanks 1 150.00 1 <br /> S <br /> U <br /> R TEMPORARY CLOSURE (Doty allowed one tie@ for up to two years) <br /> F <br /> TEnPORARY CLOSURE FEE = 400.00 each TANK 1 Tanks 1 $80.00 1 <br /> P PLAN CH1:CK (Instillation or Repair) <br /> E _ m <br /> A <br /> N PLAN mm FEE K 430.00 each SUBMISS14N1RESUBNISSION 1 <br /> REPAIR <br /> E TANK REPAIR FEE a $110.00 each TANK 1 Tanks__ — z $110.00 1 <br /> P <br /> A PIPING REPAIRICLOSURCIRtM00L (fees are per hour, minimum ane hour to be paid on plan submittal) <br /> t <br /> R UNAUTHORIIED RELEASE EVALUATION CONSTROM ON INSPECTION SAHPLING INSPECTION <br /> (when applicable) (vhen applicable) (when applicable) <br /> FEE = $30.00lhr FEE _ $33.00lhr FEE _ $35.401hr ! <br /> .. TOTAL DUE <br /> offler USE My <br /> SWEEPS 1 COMP 1 LDC CODE D13T COOS Ah6UNT Out AMOONT REVD C8ECK 11GASH R00 OY DATE RECEIVED PERMIT 1 <br /> i i :� 11pliklimmiI Ing ` <br />