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TANK(s) <br />•� LNmERGROWm STORAGE TANK PRtJI /� <br />' FACl CITY CONTACT 1 / ,_/ <br />IN <br />G <br />10m� <br />_ <br />I <br />Y1.. tj SITE PHONE Y with AREA COD?, ?q;V -336 <br />fit✓ N a <br />TE <br />21P CODE X of TANKS <br />at SiTE <br />( <br />t <br />APPLICANT CONTACT NAME�� 1Y, <br />APPLICANT/ NG NA <br />� <br />�1 <br />APPLICANT PHONE C 111 Tj;, A <br />GG.�Q C1 <br />MAILING ADDRES <br />F` <br />`/ <br />APPLICATION <br />TYPE of APPLICATION <br />ltsL'1-C� <br />I T TEI <br />�Px y <br />b <br />I (Closure, on, etc.) <br />iCITY <br />.S <br />TOTAL <br />` <br />1986 11987 11988 11989 11990 <br />s <br />to January 1, 1991 S100.00 <br />XXX% X%X% <br />I <br />ANNUAL FACILITY FEE (Prior <br />xxxX � ><xxx I 1 1 vo S r O4 <br />I xxxx I <br />FACILITY PENALTY FEES ASSESSED (If Applicable) ST70/TANK (After January 1, 1991) <br />FEE 550.00/TANK <br />(Prior to January 1,1991) <br />11993 1994 11995 11996 <br />/ TANK <br />" <br />C Tanks • <br />1906 11987 11988 1989 11990 1991 11992 <br />I /70 I / 7d I / �oI riv I S <br />- (twlttP(Y booy—ytee for <br />icnole) <br />X XXXX I X%%% �J I �� - _ <br />I <br />I S yr,� <br />A each year apgl <br />1 TANK PENALTY FEES ASSESSED <br />XXX% I KXXX I XXXX I I �� •5287 <br />See California H 8�1Cooe <br />j STATE SURCHARGE = S56. DO each TANK (Due every 5 Years) <br />ough 1996 <br />T <br />1986 through 1990 S 1 <br />z 556.00 <br />(Enter amotatt and Year) <br />� <br />Closure -in- Place) TANK I.D. N(s) <br />S <br />c ANENT CLOSURE (Removal <br />or Authorized X 574 DO = <br />LI P_RM <br />Lt7E.00/hour (3 hours mtnlmua/TANK) <br />OI CLOSURE FEE = I TANK I.D. --(S)— <br />SInspections) <br />U TEMPORARY CLOSURE (Plan Review 1 I S234.00 minimm <br />e TEMPORARY CLOSURE F'cE = 578.00/hour (3 hours mini nrtn/f AC1 L1TY) <br />P INSTALLATION PLAN CHECK (Plan Review L Construction Inspections) TANK I.D. #(s)._— <br />L$624.00 minimum <br />A platy CHECK FEE S7E.00/hour (8 hours minimum/FACILITY) y <br />EM 23 032 (REVISED 4-29-94) <br />S <br />S <br />/;1/'(i -7-0700. <br />,1.%1oT Tiro e-'1R/1,aCE <br />