Laserfiche WebLink
ICES - <br /> IAL <br /> SAM JOACUIN 1UW0 RGRO( 31CCER/AIGENTANKYPROGRAM£MVFEE WORKSHEET <br /> FACILITY <br /> DIYSION n <br /> FACILITY CONTACT W, V <br /> f�lENAHE <br /> Jollo Doucette <br /> ACME Saw and Industrial SuQ SITE PHONE / with AREA CODE <br /> Elry ADDRESS (20 )_948-6 35 <br /> 1204 E. Main St. I of TANKS <br /> STATE LIP LOGE <br /> CA 95205 at SITE 2 <br /> 1 CITY <br /> A St2 kton, APPLICANT CONTACT NAHE <br /> P <br /> P APpLIcANT/BILLING NAME Same as above same as above <br /> L .�-- <br /> I )-101 ICANT P}IONE S IIiTN AREA COOT <br /> C NAILING ADDRESS , <br /> A <br /> N STATE ZIP CODE TYPE of APPLICATION <br /> 1 Cify CA 9 52 (Closure, installation, at ft al <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January i, 1991) S100.00 f <br /> A f <br /> C xxxx xxxx <br /> I FACILITY PENALTY FEES ASSESSED (If Applicable) <br /> t170/TANK (After January 1, T991) <br /> I TANK FEE 150.00/TANK (Prior to January 1,1991) <br /> E 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1446 <br /> R Tanks - <br /> f <br /> F (mutt[ply N by fee for <br /> A each year applicable) S <br /> C <br /> I TANK PENALTY FEES ASSESSED xxxx xxxx <br /> I STATE SURCHARGE ■ 156.00 each TANK (Due every S years) 529 <br /> L See CaliforniaCatlforna N b 5 Code, Section <br /> T - 1996 through 1990 1991 through 1996 <br /> Y A Tanks__ x 156.00 IT <br /> (Enter Amount and year) X <br /> TANK I.D. S<s) <br /> C PERIIANENT CLOSURE (Re=vel or Authorized C(osure-in-Place) '4 68.� <br /> 5234.00 ■ <br /> 0 CLOSURE FEE S !78.00/hour (3 hours minimum/TANK) <br /> STANK I.D. 0(s) <br /> U TEMPORARY CLOSURE (Alen Review & Inspections) f <br /> R1 TANK(s) X !234.00 ■ <br /> F <br /> TEHpORARY CLOSURE FEE ■ 178.00/hour (3 hours minimum/TANK) <br /> p INSTALLATION PLAN CHECK (Plan Review & Constructlon�Inspec�tfOns) TANK I.D. !(s) <br /> L f <br /> A ■ !624.00 minimum <br /> N PLAN CHECK FEE a 178.00/hour (8 hours minimum/FACILITY) <br /> R REPAIR FEE (uorkpten Review R Construction inspections) <br /> TANK I.D. 0(s) <br /> E ■ $78.00/hour (3 hours minimum/TANK) 0 TANK(s) X .5234.00 ■ : <br /> P TANK LINING REPAIR FEE 5 <br /> A ■ 5234.00 minimum <br /> 1 TANK RETROFIT REPAIR FEE ■ $78.00/hour (3 hours min./FACILITY) f <br /> ITPIPINGREPAIR FEE . t78.00/hour (3 hours minimum/FACILITY) ■ 5234.00 mint" <br /> N TRANSFER FEE ■ $20.00 UNAUTHORIZED RELEASE EVALUATION <br /> ■ %78.00/hr 5 <br /> I IT <br /> S ■ %78.00/hr <br /> C CONSULTATION FEE • $78.00/hr SAMPLING INSPECTION FEE <br /> ft-f:_ <br /> TOTAL DUE S468-00 <br /> mnnmrtn+ m. n!nmm <br /> FOR OFF ICE USE ONLY u mun�!!ac�ra!o�mSruueu�c!t{eaan <br /> :.ammo am m mr mamnn mon mr!iml mra r rnn oc^a!� np1mmnm u°iii u im 7 niiTn re�!1!!na.! m�� n ,en` n!n�u'nu"l5nc a iL rnAx ' DATE RECEIVED <br /> r naa!mr { 51 <br /> m u!!.!!n ni!�m u!u u,! nwrunr�imrn�!9lRl N !u _ <br /> Epi 1\ CObfPUteR- 1- .LOC CODE DIST CODE AMOUNT RECEIVED CHECK /CASH RECEtY� 9 <br /> • �/ 3�.j f .�.� Y.G'U /1 n ,mIIm!ngrnr. <br /> xu uuri mr�.'a!a:!mmn!.n. n�.�.�i •a• !! :H <br /> iiia{►{ice! {{ ! ! ! ! lul EliKu 12-1 Di 01 ! .t"m rsare amau�v <br /> ' pl qe IT <br /> EH 23 032 (REVISED 1T 1 92) <br />