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SAN UIN LOCAL HEALTH DISWT <br />UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br />F <br />FACILITY/SITE NAME <br />FACILITY CONTACT NAME <br />A-- <br />1989 <br />T <br />41' 11 U1h ('0�� nn �� r <br />s; I�'^ <br />1 <br />[ <br />L <br />STREET ADDRESS t <br />�f <br />SITE PHONE 1 WITH AREA CODs <br />L! Ca 6� L s Ct N t <br />z / !zC L- FF 7L <br />E <br />TANK FEE = 150.00 each TANK <br />F <br />t Tanks�x 150.00 �. <br />� 1986 � <br />Y <br />CITY <br />%C`C�-.TZIw" <br />STAT <br />L ci <br />iIP CODE <br />�',J"Z C, <br />i of Tanks % <br />at Site <br />A <br />APPLICANT/BILLING NAME <br />APPLICANT CONTACT NAME <br />----- <br />.�Tv��_n°n,���tzv� ,�n4r, P,� <<(L,,i, �rvc <br />I <br />MAILING ADDRESS, <br />APPLICANT PHONE t WITH AREA CODE <br />1 <br />C <br />I <br />N <br />T <br />CITY (1 <br />STAT <br />iIP CODE <br />TYPE of APPLICATION <br />CLOaURE. INRTAIIATtON, ETC. <br />1986 <br />.1 CCkrb tV ; L'!1 _��. <br />1988 <br />Zc'j <br />C <br />L <br />FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR <br />TOTAL <br />A-- <br />1989 <br />T <br />1986 _ 1987 1988 _ <br /># tanksx f90.00 <br />1 <br />[ <br />RTEMPORARY <br />E <br />1 <br />1 <br />[TEMPORARY CLOSURE FEE = 180.00 each TANK <br />1 Tanks x 180.00 <br />E <br />TANK FEE = 150.00 each TANK <br />F <br />t Tanks�x 150.00 �. <br />� 1986 � <br />1987 <br />1988 <br />1989 <br />A <br />(sultipTy_0_ by fee for <br />----- <br />1 <br />C <br />I <br />each year applicable) <br />—_ <br />L <br />STATE SURCHARGE = 156.00 each TANK (see CA HEALTH It SAFETY CODE Sec 25287 for applicability) <br />T <br />Y <br />1 Tanks'" x 156.00 <br />(enter iiiiit and year) <br />1986 <br />1987 <br />1988 <br />1989 <br />1 <br />C <br />L <br />PERMANENT CLOSURE (Removal or Closure -in-place) <br />- <br />0 <br />CLOSURE FEE = 190.00 each TANK <br /># tanksx f90.00 <br />1 <br />U..____ <br />RTEMPORARY <br />E <br />CLOSURE (Only alloyed one time for up to two years) <br />1 <br />[TEMPORARY CLOSURE FEE = 180.00 each TANK <br />1 Tanks x 180.00 <br />1 <br />P <br />PLAN CHECK (Installation or Repair) <br />L <br />--- <br />A <br />.- <br />N <br />PLAN CHECK FEE = 130.00 each SUBMISSION/RESUBMISSION <br />1 <br />REPAIR <br />TANK REPAIR FEE = 1110.00 each TANK t Tanksx 1110.00 f <br />A PIPING REPAIR/CLOSURE/RENOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br />I _ �. ._ <br />R UNAUTHORIIED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br />When applicable) (when applicable) When applicable) <br />FEE = 130.00/hr _._ FEE = 135.00/hr FEE = 135.00/hr� 1 <br />OFFICE USE ONLY <br />