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r Y. <br /> SAN ,OAEINTLECT1IIENY10E$ <br /> RQMALHEANDVSOi <br /> WIDERGROM STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACIL17Y CONTACT HAME6", lvk>.aTlo <br /> A <br /> 1 FACILITY ADDRESS E PHONEwi> AREA CSE S�� <br /> L 2-F0( <br /> TCITY E ZIP E� 0 of TANKS <br /> �' CJS at SITE -...._.. <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT MA14E <br /> P <br /> CIV LING TRESS � APPLICANT P E 9 WITH AREA CODE <br /> •A — �l1,TE P CODS ' TYPE of )PLICATION' <br /> N GI C,f{ CLOSURE INSTALLATION etc. <br /> TOTAL "-- <br /> A 1996 1987' 3988 1989 1990 —� <br /> T ANNUAL FACILITY FEE (Prior to JarMary 1. 19p1) a 5104.00 <br /> I i <br /> E TANK FEE _ $50.00/7ANK (prior to January 1'.1991) $170/TAMK (after Jwx4ary 1, 1991) .� <br /> F I Tanks 1966 1987 1988 19a9 1990 1991 1992 3993 1994 1995 1996 <br /> A wLtiply €Tfea for <br /> C each year applicable) <br /> STATE SURCHARGE ■ $56.00 each TANK (Rue every 5 yearn) $n California N L 6 Code, Section 25287 <br />` i # Tanks x $56.00 1986 through 1990 1991 through 1996 _ { <br /> T (enter emour►t and year) —._..._ <br /> S <br /> PERMANENT CLOSURE (Removal or Authorlaed Closurs-ln-PL#ce} TAMC I.D. #(e) <br /> L CLOSURE FEE • $53.00 per hour (3 hours mini" per TANK) � TANK($) x $159.00 � i • — <br /> S <br /> TEMPORARY CLOSURE (A aig-time permit, for COVIOi+/inrp000O a) I TAMC I.O. 9(s) — <br /> El TEMPORARY CLOSURE FEE ■ S150.Q0 each TANK / TANK(s) 1( $150.00 ■ f -- <br /> P PLAN CHECK (install., Plan Review i Conatcwtion Inspectiani) TASK 1.0. #(a) - ---_ <br /> L <br /> H PLAN CHECK FEE - 653.00 per hour (a hours mfnlm per FaCitity) + $424.00 minium i <br /> R REPAIR FEE (workplan review i conetruCtion Inspections) I.D. •(a) <br /> P TANK REPAIR FEE ■ $53.00 per hour (3 hours minlaEua�/TANK7) T#"7TA NK(s) x $159.00 $ <br /> A <br /> R PIPING REPAIR FEE ■ $53.00 per how (3 hour minims per fooliity a $159.00) f _ <br /> M IRAHSFER FEE + $20.00 UNAUTHORIZED No CAN EVALUATION <br /> C —CONSULTATION FEE _ $53.00/hr SAMPLING INSPECTION FEE + $53.00/hr : <br /> TOTAL DUE S <br /> ibk1 .c:Ui-1f:: <br /> ud � <br /> 4u <br /> h <br /> IIIRIIIIII�IIIk f:E4l;•GYJ EWYWfli91,E4:::'G:'IJ - <br /> 1.:: f4 iLJWL W <br /> EN 23 032 (Revised 4/a/91) Peso 11 <br /> ' ,y <br />