Laserfiche WebLink
-"'v. '-'_ •. ..u�.F1L HcvaLIH I)ISINICI <br /> t <br /> _ UNDERGROUND STORAGE TANK PROGRAM - FEE YORKSHEET <br /> �fACILITY/SITE NAME \V <br /> A / _ fACILIIY CONTACT NAME <br /> C re v76✓"f j <br /> I <br /> L STREET ADDRESS <br /> i <br /> SITE PHONE 1 WITH •-e• coo, <br /> Y CITY <br /> ST T 11P CODE 1 0l Tanks <br /> SCo ` Joy at Site <br /> A APPLICANT/BILLING NAME <br /> P APPLICANT CONTACT NAME <br /> P <br /> I MAILING ADDRESS <br /> C APPLICANT PHONE 1 WITH •+_A coot <br /> A <br /> H CITY <br /> 1 STAT IIP CODE TYPE of APPLICATION <br /> aa=ueq r.=re�cwn <br /> ON, (YC. <br /> AFACILITY FEE = 1100.00 each SITE ADDRESS per YEAR <br /> — <br /> C 190E TOTAL <br /> 1981 1988 1909 Q <br /> V n r <br /> E TANK FEE = 150.00 each TANK <br /> f I Tanks1 r 150.00 1986 1917 <br /> _ <br /> A (mullipfy by fee for 1988 1989 <br /> C each year applicable) <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH L SAFETY CODE Set 25281 for applicability) <br /> I <br /> T I Tanks a 156.00 1986 <br /> Y (enter iiouit and year) 1981 1988 1909 <br /> 1 c <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) c <br /> L <br /> 0 CLOSURE FEE = 190.00 each TAN <br /> S I tanks m (90.00 { <br /> U <br /> R TEMPORARY CLOSURE (Only allowed one time for up to Years) <br /> E <br /> TEMPORARY CLOSURE FEE = 180.00 rice TgNK <br /> 1 Tanks r 100.00 1 <br /> P PLAN CHECK (Installation off " <br /> L <br /> A <br /> N PLAN CHECK FEE = 130.00 each SUBMISSIifN/RISUBNISSION <br /> f <br /> REPAIR <br /> R TANK REPAIR FEE = 1110,00 each TANK <br /> PI Tanks_ r 1110.00 { <br /> --- -- _ <br /> A PIPING REPAIR/CLOSURE/REMOVAL (fees are per hour, minimum one hour to be paid on plan submittal) <br /> I <br /> R UNAUTHORIIED RELEASE EVALUATION CONSTRUCTION INSPECTION <br /> (when applicable) (when applicable) SAMPLING INSPECTION <br /> (when app <br /> FEE = 170.00/hr T li(able)FEF = 435.00/hr <br /> FEE = 435,00/hr 1 <br /> OFFICE OSE OILY TOTAL DUE { <br /> l� <br /> SV€EPS h CQMP• 1 OC CODE DIST CODE �OUHT Ui1E� AR Nl�l(1 ptVB CHECK I/CASH RCVD BY DATE RECEIVED PERMIT I <br /> I�CIi�l�w1�9��1�{Indl�(IkM:'AIOM6191RIfWIID17C01pA- <br />