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8-25-1998 3:59PM FROM <br />SAM JQAOUIX )ECIC NEALTB SERVICES - SWIROMPEXTAX. MICK <br />uxueRG2mim SLDRAGE TAMC PROCRAM - FEE UOMMIZINIEEr <br />P. 5 <br />S <br />FACILITY SITE': y <br />� r <br />T� <br />( 1988 ' 1989 5490 <br />ANNUAL FACILITY FE=.CPrior <br />A <br />to January I, 1991) = S100.Q0 <br />'E <br />FACILITY AWkESS <br />SITE P +ith AREA =F- <br />TSE00 SZ.5-0t7ej- <br />00`0 <br />A <br />CITY�q <br />1"�an^CA <br />STATE <br />�C�1. <br />lLP CCOE <br />X15336 <br />C of TAUXS <br />ar SIT` <br />I <br />P <br />p <br />L <br />APPLICANTIBIL�LING WE �/, �^ Y' G <br />L o�J <br />APPLICANT CT.DITACT VAME <br />Is <br />n 1J 5' 1' , <br />(Prior to Jam-rY 1,1991) <br />I <br />C <br />MAILING AOORESS' <br />Po l l (31 vd <br />APPLICANT P`lONE 3 WITH AREA CME <br />O <br />A <br />k� s-7 No. /�G wc. <br />707 S— 66 <br />T <br />CITY <br />STATE <br />CA <br />ZIP CME <br />Cf �1 _CI <br />TYPE of APPLICATION NGcJ $%0V%: 0V_k' <br />(Cure, Iaszailariarr, etc_) ►oJ <br />t ut—T4 <br />Cl PE-qMANOT CLOSUPE (Removal or Auzhorized CtaSure-in-Ptac) <br />I <br />Lr <br />` 0) CLOSURE F= 7 578.00/bo r (3 hours mini= aa/TASK) <br />S <br />W' Te"CAAY CLOSURE (Plan Zs_view 3 C10pac== ) <br />R <br />E. .MWORARY CLOSURE Fa. = 578_00/hour (3 hours min7im.WFACS1.I7T) <br />TANK C.,1_ _(s) <br />a• TANKS) x S;54.W = S <br />TANK I.J. AS) <br />$234.20 ainimua � S <br />P; (NSTALLtTICIN PLAIT CIiELZ (Ptah Review 6 Cas=frac=ion iupr=forst)! TANK 2-3. =ls) <br />Ll <br />AlkPLAN csEcK fE = S78-00/hour CS hours miniimss/fACIL.M = W4..00 minimAx s <br />R{ 2VAIR FE_: CVorjWLan Revive 4 Camtru=ion Enspectios=) ! TAXK I.D_ As) - <br />E, <br />Pf TANK LIMING REPAIR FEE - S18_GQ/hour• C3 hours minimum(TAXO ! s TANK(S) X SZ34.J0 i <br />A <br />I TANK FIT REPAIR FEE = 578_00/hoot C3 hours Dein./FAC:LITTl = SZ14_M minimaar } S <br />R <br />?!PING U5 AIR r -e=- = 278_0a/bora- C3 flours minim mlFACILtTT) = 3;34.00 zinimum � S <br />xi T'ZANS,-;�2 Fa =570.00 lNtAtlTt lIZEtI .QFL°AS' EVALUATIC'Y s 578.C10/hr S <br />5' <br />C: C=lSULTATTC9 FEE = S78.Wfhr ( SWUNG IxSFECTTCx Fa = S78_QO/hr i I S <br />MrAL ouE S <br />FOR OFFTCF USE ONLY <br />SUES A j CCMPUTER 3 LCC CCOE t7IST =E i APCUNT REG*vim 1 CWcx d/CXV ! RE�.Ij0 S7 GATE <br />U <br />EH 23 03Z (REVISED T-12-98) <br />Im <br />REM -1140 <br />1986 1487 <br />( 1988 ' 1989 5490 <br />ANNUAL FACILITY FE=.CPrior <br />A <br />to January I, 1991) = S100.Q0 <br />xxxx � xxxX <br />X)Ix)I ! xXXx � XxxX <br />S =omctx <br />C <br />T rACi LI'TY PF_XALTY FE`S ASSES"SO C I f Appl i cabt e) <br />I <br />700CC =a IOCXJL =a f =0C <br />Is <br />Y TANx Fa = SSO.00/TAOX <br />(Prior to Jam-rY 1,1991) <br />S17U/TAxK (Atter .Lanuary 1, 1491) <br />s: <br />3 Tanfcs = <br />148$ 1989 l Two 11491 199Z + <br />1993 199, ( 1495 1996 1 1997 1998 <br />F (multiply by fee for <br />A tach year appticabte) <br />f <br />XXXX XXXx I X7C0C ( xca I=a + <br />I <br />5 <br />Ii <br />TANK ;'"ALrY FEES ASSEn D <br />II <br />f M= xxxx zxxx laool �xxxx i <br />1 1 <br />! i ! t <br />S <br />L <br />11 STATF SURClARG FCR VEU FAC-LITtES ONLY-gsta.SQ <br />3 <br />Ts -- <br />7 Tanks x S$.00 <br />1988 through 1443 C356) <br />1993 1497 0356) -.998 <br />Std MARGE FOR 1998 <br />Cl PE-qMANOT CLOSUPE (Removal or Auzhorized CtaSure-in-Ptac) <br />I <br />Lr <br />` 0) CLOSURE F= 7 578.00/bo r (3 hours mini= aa/TASK) <br />S <br />W' Te"CAAY CLOSURE (Plan Zs_view 3 C10pac== ) <br />R <br />E. .MWORARY CLOSURE Fa. = 578_00/hour (3 hours min7im.WFACS1.I7T) <br />TANK C.,1_ _(s) <br />a• TANKS) x S;54.W = S <br />TANK I.J. AS) <br />$234.20 ainimua � S <br />P; (NSTALLtTICIN PLAIT CIiELZ (Ptah Review 6 Cas=frac=ion iupr=forst)! TANK 2-3. =ls) <br />Ll <br />AlkPLAN csEcK fE = S78-00/hour CS hours miniimss/fACIL.M = W4..00 minimAx s <br />R{ 2VAIR FE_: CVorjWLan Revive 4 Camtru=ion Enspectios=) ! TAXK I.D_ As) - <br />E, <br />Pf TANK LIMING REPAIR FEE - S18_GQ/hour• C3 hours minimum(TAXO ! s TANK(S) X SZ34.J0 i <br />A <br />I TANK FIT REPAIR FEE = 578_00/hoot C3 hours Dein./FAC:LITTl = SZ14_M minimaar } S <br />R <br />?!PING U5 AIR r -e=- = 278_0a/bora- C3 flours minim mlFACILtTT) = 3;34.00 zinimum � S <br />xi T'ZANS,-;�2 Fa =570.00 lNtAtlTt lIZEtI .QFL°AS' EVALUATIC'Y s 578.C10/hr S <br />5' <br />C: C=lSULTATTC9 FEE = S78.Wfhr ( SWUNG IxSFECTTCx Fa = S78_QO/hr i I S <br />MrAL ouE S <br />FOR OFFTCF USE ONLY <br />SUES A j CCMPUTER 3 LCC CCOE t7IST =E i APCUNT REG*vim 1 CWcx d/CXV ! RE�.Ij0 S7 GATE <br />U <br />EH 23 03Z (REVISED T-12-98) <br />Im <br />REM -1140 <br />