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UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br />u tau use oatr <br />SWEEPS t I COMP t ILOC CODE DIST CODE AMOUNT DUE I AMOUNT RCVD C)IEr,Y. 1/r,ASH ff,V0 BY DATE RECEIVED PERMIT I <br />--7W-1- <br />---- ..-- <br />1�rw ,rc3o <br />1t tAC/IL•ITT/SITE MANE —i—"-- <br />14 / % � / FACILITY <br />— <br />L STREET ADDRESS <br />T-� ` - / /PCr� / <br />_.�.�� <br />SITE NE 19rX AREA CODE <br />Y CITY //Y <br />4cz' STATE ZIP CODE 1 of Tanks <br />Site <br />—_---�P62o$— <br />at <br />— <br />A APPLICANT/1111.1.1116 NAME <br />P <br />APPLICANT CONTACT NAME <br />S.TC Scl ��s------17/ <br />I MAILING ADDRESS <br />• <br />A <br />C_,�1� <br />— — APPLICANT PHONE 1 WITH AREA CODE <br />-t—.IZI rate_.___.__ <br />�� YYy�YO7� <br />X CITY <br />T% <br />TATE i1P CODE TYPE of APPLICATION <br />jlr�� IT o��y�-� CLDeueE, INSTALLATION, ETC. <br />I <br />FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR <br />—y y <br />C <br />1386E— <br />1987 1388 1983 <br />TOTAL <br />E <br />TANK FEE = SSO.00 each TAI i <br />F <br />A <br />I Tanks x 550,00 1986 <br />I ultipiy 1 -by fee for <br />1387 1988 _ 1383 <br />each year applicable) <br />$ <br />L <br />1 <br />STATE SURCHARGE = $56,00 each TANK (see CA HEALTH <br />--- <br />It SAFETY CODE Sec 25287 for applicability) <br />T <br />Y <br />1 Tanks z $56.00 1386 <br />(enter ai055t and year) <br />1907 1388 1383 <br />— <br />C <br />PERMANENT CLOSURE (Removal or Closure in place) <br />� — -- <br />0 <br />CLOSURE FEE _ $10.00 each TANK <br />1 Tanks f z $90.00 <br />f <br />o <br />R <br />E---- <br />TEMPORARY CLOSURE (Only allowed one time for up to <br />two years) <br />TEMPORARY CLOSURE FEE _ $80.00 each TANKTanks <br />-- <br />z $90.00 <br />S <br />PLAN CHECK (Installation or Repair)------ <br />IP <br />L <br />_--~ <br />A <br />—_ _---'---- <br />11 <br />PLAN CHECK. FEE _ $30.00 each SUBMISSION/RESUDMISSION <br />S <br />REPAIR <br />P. TANK REPAIR FEE = $110.00 each TANK <br />E —-----------____ <br />1 Tanks z $110.00 <br />__.._ - - - <br />f <br />P — <br />A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to he paid on plan submittal) <br />R UNAUTHORIZED RELEASE EVALUATION <br />CONSTRUCTION INSPECTION SAMPLING INSPECTION <br />(when applicable)_-- (when applicable) (when applicable)- <br />FEE - 130.00lhr FEE : 135.00/hr <br />--- ---- <br />FEE _ $3S.00/hr <br />---1-- <br />$ <br />TOTAL DUE <br />$ <br />U. <br />u tau use oatr <br />SWEEPS t I COMP t ILOC CODE DIST CODE AMOUNT DUE I AMOUNT RCVD C)IEr,Y. 1/r,ASH ff,V0 BY DATE RECEIVED PERMIT I <br />--7W-1- <br />---- ..-- <br />1�rw ,rc3o <br />