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1-21-1997 8:33AM FROM SAI! dWW11J PUBLIC REALTH SERVICES - SWIRDMN1�11AL&TH DIVISICH 3 tAMER6NtDUIID STORACE TAMC PR mba - kR£ ummsmEET P. 4 5 FACILITY SITE NAME FACILITY CONTACT NAME T �►Li �. d (Z F S ANNUAL FACILITY FEE CPrior to January 1, 1941) = 510(1.00 N PLAN CHECK FEE = $73.00/hour CS hours miniMUWFACILI ) _ $G26.00 minim= E PACI ITT ADDRE SITE PHONE with AREA CACHE A I w Lv C� - o 70001 xxxx xxxx xxxx xx%x L xxxxxxxxxxxxx U TEMPMRY CLOSURE Celan Review & In6pmTi0m) A CI Y;ZATlEl �Q ! ^ Z� CME at f TAN= SITE MWORARY CLC1SLME FEE = $78.001how C3 hours mini FACILITY) $736.0o mint no S T 1. 1� � Xxxx mm xxxx xxxx $ xxxxxxxxxxxxx P P APPLICANTAILLING NAME APPLICANT G=TAcT mm ` Y TANK FEE SSFI.(C/TARK (prior to January 1,1991) C 14ALLINr ADDRESS � APPLICANT PHONE # WITH AREA CME A A` Tanks = 1966 19$7 1965 1989 1990 T CITY LJ `'� STATE: CP Z P MO€ 3 TYPE Of APPLICATION (CLoswe, Installation, etc.) TOTAL PERMANENT C1_CCaME (Reuoval or Authorized Closure -in-place) TA$K I.D. ilts) 19&1 1"7� 1988 � l989 1g90 TAXI( LINING REPAIR FEE ■ 578.00/hour 43 hcws amini1 TANK) A TANK(S) x $04.00 _ ANNUAL FACILITY FEE CPrior to January 1, 1941) = 510(1.00 N PLAN CHECK FEE = $73.00/hour CS hours miniMUWFACILI ) _ $G26.00 minim= r a CLMJR9 FEE _ $78.00/hour (3 hours miniausNTANK) A S 70001 xxxx xxxx xxxx xx%x L xxxxxxxxxxxxx U TEMPMRY CLOSURE Celan Review & In6pmTi0m) TANK I.D. 9(S) c PIPING REPAIR FEE = 57$.00/haur (3 hours minimmVFAGILITY) = S234.DD minimm R E MWORARY CLC1SLME FEE = $78.001how C3 hours mini FACILITY) $736.0o mint no S T FACILITY PENALTY FEES ASSESS® (it AppLicabic) 7D000 Xxxx mm xxxx xxxx $ xxxxxxxxxxxxx I Y TANK FEE SSFI.(C/TARK (prior to January 1,1991) 51 TANK CAfter January 1, 1941) E A` Tanks = 1966 19$7 1965 1989 1990 1991 199E 1993 W% 1" 1996 F _ CmuLTipty $ by free for x7CXx CC)3C 11 'AD 7C S A each year a ppl i rab l e) XX7Df G i TANK PENALTY FEES ASSESSED I xx xxxx X)=X)fXX xxxxk ( S L I STATE SURCHARGE = 556.00 each TANK CDwt rvdry 5 s) See California H S 5 Code, Secsian 25287 T T # Tm*s_ x '156.00 198$ through 1 1941 thrpu9h 19% CEnter aMaUnt and year) t C PERMANENT C1_CCaME (Reuoval or Authorized Closure -in-place) TA$K I.D. ilts) L A TAXI( LINING REPAIR FEE ■ 578.00/hour 43 hcws amini1 TANK) A TANK(S) x $04.00 _ L N PLAN CHECK FEE = $73.00/hour CS hours miniMUWFACILI ) _ $G26.00 minim= r a CLMJR9 FEE _ $78.00/hour (3 hours miniausNTANK) $ TANK(S) X $234.00 = S S s U TEMPMRY CLOSURE Celan Review & In6pmTi0m) TANK I.D. 9(S) PIPING REPAIR FEE = 57$.00/haur (3 hours minimmVFAGILITY) = S234.DD minimm R E MWORARY CLC1SLME FEE = $78.001how C3 hours mini FACILITY) $736.0o mint no S P INSTALLATION PLAN CRECK (Plan Review $ Canitractiannspectians) TANK I.D. dlCs) L A TAXI( LINING REPAIR FEE ■ 578.00/hour 43 hcws amini1 TANK) A TANK(S) x $04.00 _ 3 N PLAN CHECK FEE = $73.00/hour CS hours miniMUWFACILI ) _ $G26.00 minim= r 2 REPAIR FEE (Lbrieplan Review 8 Cans=radian Iampecri-r ) � TANK I -D. iks) E P TAXI( LINING REPAIR FEE ■ 578.00/hour 43 hcws amini1 TANK) A TANK(S) x $04.00 _ 3 A I TANK RETROFIT REPAIR FEE = 578.00/bour a hours min./!FACILITY) - 5234.DD minimus s a PIPING REPAIR FEE = 57$.00/haur (3 hours minimmVFAGILITY) = S234.DD minimm 5 If TRANSFaR FEE z t7C.C)0 I VXAtlY*Wl= RELSAS£ EVA"TION = 17$.X/ht 5 i S ClCONSULTATION FEE _ 178.001hr SAmftj)iu iNSP6CT om Fa = 178.08/hr s til'? E USE OMT 01-21-1997 09:31AM P.04