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4-08-1997 3:06PM <br />S FACILITY SITE NAME <br />E FACILITY ADDRESS <br />>t 1—! 0 , <br />CITY <br />A <br />P <br />P APPLICANT/BILLING NAME <br />C Mg (LI NG ADDRESS <br />N In <br />Y CITY <br />FROM P. 1 <br />0 0 <br />• ,• • NAIL , . <br />r FACT ITY CONTACT NAME <br />r <br />S37 PHI�1 # ith AREA CODE <br />�A..% �!�7 - ll- <br />S1ATE ZIP COOS # of TANXS <br />Get at SITE <br />AP, ICANT CONTACT NAME <br />r- fit--• h/ � �� <br />APPLICANT PHONE # WITH AREA CODE09 8 f5 <br />ATE CODE TYPE of APPLICATION Z44 <br />(Closure, Installation, etc.) ,i crx <br />rnre� <br />PERMANENT CLOSURE (Removal or Autharized Closure -in -Place) <br />TANK I.D. #(s) <br />L <br />CLOSURE FEE = 578,00/hour (3 hours minima /TANK} <br /># TANK(s)x 8234.00 = <br />$ <br />S <br />U TEMPORARY CLOSURE (Plan Review & Inspections) <br />TANK I.D. #(s) <br />R <br />E TEMPORARY CLOSURE FEE = S78.00/hour (3 hours mini /FACILITY) <br />$234.00 minimum$ <br />— <br />P INSTALLATION PLAN CHECK (Plan Review & Construction Inspections) <br />TANK I.D. #(s) <br />L <br />A <br />N PLAN CHECK FEE n $78.00/hour (8 hours miniaRlm/FACILITY) <br />= $624.00 minimum <br />$ <br />R REPAIR FEE (Workplan Review 8 Construction Inspections) <br />TANK I.D. #(s) <br />E, <br />P TANK LINING REPAIR FEE a $78.00/hour (3 hours minimum/TANK) <br /># TANK(s) X $234.00 = <br />ffi <br />A <br />R. RETROFIT REPAIR FEE _ $78.00/hour (3 hours min./FACILITY) <br />= $234.00 minimum <br />S <br />TANK <br />�— <br />PIPING REPAIR FEE = $78.00/hour (3 hours aninimum/FACILITY) <br />= $234.00 minima <br />S }/ <br />MTRANSFER FEEUNAUTHORIZED RELEASE EVALUATION = $78.00/hr <br />$ <br />I <br />St- <br />Cj <br />----------- <br />CONSULTATION FEE _ $78.00/hr SAMPLING INSPECTION FEE _ $78.00/hr $ <br />EH 23 046 (Revised 7/10/96) Page 11 <br />