Laserfiche WebLink
11-06-1298 10:24AM FROM <br />SANTY PO.IBLIC NEALTN SERVICES - &MI AL 01VVOw <br />UNOEi3 NO a TANK w - }fir <br />S� FACILITY, SITE MANE <br />Ti and <br />$ FACILITY ADDRESS <br />& ter <br />j CITY e,r <br />A 0� <br />P <br />Pt APPLICANT! ILLIN NAME <br />LS <br />I <br />C; NAILING ADDRESS <br />V V rY <br />FACT TY OWAV NAME <br />Ld'dZ t 1 <br />$IT* PNONE A ui th AREA CDOL= <br />a <br />TATE ZIP CODE i of TANKS <br />at SITE <br />APPLICANT CUT CT <br />APPLICANT TE $ WI;X ARRA CODE <br />TATE ZIP <br />CODrE1-pi /y 1"E of 7W N <br />tat! et:. ) <br />C`. PERMANENT CLOSURE (ReMOva! or AUCfteriEed Ciosure-in-Pkat) � TANK I.D. 0(s) <br />L; <br />01 CLOSURE FEE = 378.00/hour (3 haws minims=/7ANK) aSAallCdsl x 9$34. 00 S <br />s; <br />W rEMPCRARY CLCSGRE (Pian Reviews & Ivxspecriom) i TANK. !.Z. A;s) <br />R' <br />E TEMPORARY CLO$URE Faa : S73.001hour (3 hours mired FACILITY) 1 5734.00 mini4w & <br />w INSTALLATION ALAN CRECK (Pt4M Review & CanatPUCtion IAS"*Tions)l TANK I.D. e{0) <br />L' <br />A <br />Ni PLAN CHECK FE= a 978.00/Dour 1 hours mi0iMUsr/FACILITY) 56Z<.00 miMMAV <br />! 19PAIR FEE (Wcrkp(an Rev*ew 3 Ce+strwz4lon Inspections) TANK I.D. fS) <br />TANK LININ4 REPAIR PEE = 375.001 (3 hours. minim=/TANK) A TANK(s) K SU4.00 = 5 <br />I TANK RETROFIT REPAIR FEE 2 978.001hour (3 hours min.JFACILITY) a 504.00 minim= � S <br />PIPING REPAIR FEE 2 378.001hour (3 hours miniMp/FACILITY) a =4.(i0 minfam� $ <br />9I TRANSFER FEE: - $20.00 UNAUTMIZED RELEASE EYALUA710 r S78.00/hr S <br />Ci CONSUL tON ".IE ' 575.00/hr j SAMPLING IN8P4CTION FEE a 3?tJ.DO/hr S <br />A? <br />TOTAL DUE 9 <br />OR Cf9ICE USE ONLY <br />• !u r4P{ C tla'I!{N7 !lru+e runni¢ e:. mOEM <br />e:• r, ia:I s. sm:u�Eer i�E4i: iii:sl `! ,. ��-.s �m—.-..._.�._.,._.....,.--_e,:::......"="�_—.. _�..... ary ..i.:� 'm��":m3 <br />Swept a i CbMPI.ITER 0 LOC Com$ ®tsT CODE t AMOUNT RECEIVED � CHECK */CASN � RECEIVED SY - . !rte—DATE <br />xH 93 n,�a ?*Avute, 1-12-981 <br />