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SAM JOWIN COUNTY C REALTN SERVICESI AL TN DI <br /> STORAGE TANK PROGRAM - FEE ummu <br /> S FACILITY SITE NAME FACILITY CONTACT <br /> I r <br /> T <br /> E FACILITY ADDRESS SITE Pima <br /> # vi;h AREA COQ <br /> r. ® 1 �i1 <br /> CITY STATE ZIP CODE f of TANKS <br /> P at SITE <br /> P APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> if-I- <br /> VILC lit 1 'S I�� 5 C r UJ fa TTT'S <br /> C MAILING ADDRESS APPLICANT PHONE N WITH <br /> AREA CODE <br /> NeJ . r71-d`�`T <br /> T CITY STATE ZIP CODE TYPE of APPLICATION -,r\STpiV„V-t—t-ra"\ <br /> 5 SOSS T goal) (Closure, Intstaltarion, etc2-lL _V:lcp7�CYi <br /> TOTAL <br /> 4$6 1987 ( <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) S100.00 11986 1989 1990 <br /> { XXX)( XXXX } XXXX X)= xxxx S <br /> T FACILITY PENALTY FEES ASSESSED (if App(iCoble) XXX)( :Onm f XXX)t XXXX X)= ! <br /> I <br /> V TANK FEE m $50.001 (Prior to January 1,1991) SIT0/TANK (After January 1, 1991) <br /> E <br /> x Tanks a 1987 1988 1989 1940 1991 1992 1943 1994 1995 1996 1997 <br /> F (muttipty a t+y fee for <br /> A each year applicable) xxm XXXX XXxx XXXX XXXX S <br /> C <br /> I TANK PENALTY FEES ASSESSED XXXX XXXX XXXX XXXX XXXX <br /> L <br /> I STATE SURCHARGE FOR NEW FACILITIES ONLY : !18.50 ,s <br /> T <br /> Y x Tanks x S8.00 19M through 1990 ($56) 1991 through 1946 ($56) 1997 <br /> SURCHARGE FOR 1997 ! <br /> C PERMANENT CLOSURE (R t or Authorised CLosure•in-Ptace) TANK I.D. *(s) <br /> L <br /> 0 CLDSURE FEE a 578-00/hvur (3 hours minium/TAXK) P TANKS) X S234.00 o ! <br /> S <br /> U TEMPORARY CLOSURE (Plan Review & Inspections) TANK I-D. #(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = STS-00/hour (3 hours minimum/FACILITY) 5234.00 minion S <br /> P INSTALLATION PLAN CHECK (Pian Review & Comrruarion Inspectiona) TANK L.D. x(s) <br /> L <br /> A <br /> M PLAN CHECK FEE a S78.00/hour (8 hours minimuWFACILITY) ■ S624.00 minimum ! <br /> R REPAIR FEE (Workptan Review & Construction Inspections) TANK I.D. M(s) <br /> E <br /> P TANK LINING REPAIR FEL S 578.00/hoar (3 hours mini TANK) 6 TANK(s) X !234-00 s ! <br /> A <br /> I TANK RETROFIT REPAIR FEE = S78.00/honor (3 hours join./FACILITY) : S234.00 minimumS <br /> R <br /> PIPING REPAIR FEE a !78.00/hour (3 hours mini FACILITY) _ !234.00 minims S <br /> M TRANSFER FEE a 320.00 UNAUTHORIZED RELEASE EVALUATION = S78.00/hr ` S <br /> I <br /> S " <br /> C CONSULTATION FEE = S78.00/hr ING INSPECTION FEE a s76.00/hr s <br /> TOTAL DUE s sl <br /> FOR OFFICE USE OULY t <br /> „««..._.s._�"-� u �.,�•••.-�. ..tea- _.._._.... _..- - <br /> Si EPS S ! COMPUTER 0 LOC CODE DIST CODE T RECEIVED CHECK :E/CASH RUE VED SY ( DATE RZCIIV90 7 <br /> r <br /> .........:w:»::.... ...... m..,..: "it".•9 W at.�'-=j'_",r�res..s _ __ate,R�:;::.—r.: __ <br /> r <br /> _..... --:m,m:m..e::c::. v .__........_ r ._':!es:a:pa.m: am+r: =:-m-aemna'-:.^•^M <br /> '.giflllt. .:..IC .+ku—:.r......�................ ua ..«. y. ...............�....... „_•vzs....::-ii <br />