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SAN 10A0UIN CMBM F : HEALTH SERVI= - ENVIRCUMENTAL HEALTH Or <br />U1mE Z=_ S; CRAG2 TANK PROG201 - Ft'c <br />S1=AC:LITY SITE NAME <br />I } PYg-cv t 1d <br />EI ;AC:L:TY AOORESS <br />A <br />P! <br />P} APP'.:CANT/BILLING .NAME <br />L! S c-, tti <br />I I <br />C; .\IA!L•')IG ADORE --S <br />Al <br />Ti C:TY <br />ANNUAL 2AC:L(TY =c= (Prior ,o January 1, 1991) = 5100.10 <br />Al <br />C: <br />T1 =AC:L:TY PENALTY FEES ASSESSO (It Ap[icaole) <br />7986 1987 1988 11989 1940 <br />=a ` cm I =a I =a ` XXXX S t......X <br />I' <br />VI <br />FACILITY CONTACT NAME <br />(prior to lanuary <br />517i)/TANK (Atter Januar/ 1, 1991) <br />YI <br />S I i c ?.N(.N' E1/ :1� i-iwittn AROA =OE <br />1988 11989 11990 <br />i 1991 11992 11943 11992 11995 1996 ! 1997 ` .998 I <br />i�.lTE1 <br />ZIPI aT T:.NKS <br />?� <br />a t SITE 171 <br />XX= I X= I v <br />APOLICAUT =MTAC- NAME .. <br />AI <br />C i c%-- <br />. TAHKCS) X Sc=.6.10 = <br />APOLT ?ACNE + ulid AREA CODE <br />1 <br />I; <br />1 <br />TANK .'-ENALTY �==5 ASScSSc.7' <br />I j <br />X;".wn I XX C: ;CCC( <br />I XX""" I I <br />1 <br />I �.ATEI Z.'? =E I :''PE or Appuc.TICH S.U-� 76ANK \n <br />C1,lcS fi} (C:osure, (rstal.Lation, etc.) <br />�V <br />=. AL <br />ANNUAL 2AC:L(TY =c= (Prior ,o January 1, 1991) = 5100.10 <br />Al <br />C: <br />T1 =AC:L:TY PENALTY FEES ASSESSO (It Ap[icaole) <br />7986 1987 1988 11989 1940 <br />=a ` cm I =a I =a ` XXXX S t......X <br />I' <br />VI <br />".INK P = SSG.00/TANK <br />(prior to lanuary <br />517i)/TANK (Atter Januar/ 1, 1991) <br />YI <br />"anKs x <br />I <br />1988 11989 11990 <br />i 1991 11992 11943 11992 11995 1996 ! 1997 ` .998 I <br />TarKs = <br />?� <br />;rMLtioty T oy Zee tar <br />XX= I X= I v <br />I I ! <br />i rax II <br />AI <br />eBc-i year aaoL:cac(e) <br />. TAHKCS) X Sc=.6.10 = <br />S <br />1 <br />I; <br />1 <br />TANK .'-ENALTY �==5 ASScSSc.7' <br />I j <br />X;".wn I XX C: ;CCC( <br />I XX""" I I <br />1 <br />STATS .JRCSARGE -CR NEW AC:L'T:EC GPiL'=51a.=] <br />-v <br />=e_ = 578.10/hour C3 hours zirim:m/PAC:LI 7 <br />' 23 332 (REVISED <br />58.10 I 1988 �r,:,n 1943 CSSb) �}t943 <br />J_URCNARGE <br />�res:gn 7997 (S56)� 1998 <br />YI <br />"anKs x <br />I <br />S <br />=CR 1998 i 2 <br />C. <br />: <br />?E3MANENT �CS.:RE (Removal or Aur _:asur-�in'?Lac=) I <br />TANK (.7. =(s) <br />L` <br />01 <br />-c= - I <br />1SuRE • __ - 573.M/hour (3 hours .ainimuo/TANK) <br />. TAHKCS) X Sc=.6.10 = <br />S <br />S� <br />UI <br />-ciPCRARY CSURE C?tan Review 3 (nscectiarss7 i <br />TANK (.J. sl <br />R. <br />-v <br />=e_ = 578.10/hour C3 hours zirim:m/PAC:LI 7 <br />5Z34.1O ,ainimm <br />3 <br />5 1 <br />= <br />12!PCRAR7 LCSURE <br />Pf <br />:NST:.LL.ATiCN ?'-AN CHE•= (?tan Reviewi Cyst: xtion (nsar_tions)I TANK (_C. sl <br />i <br />; <br />L. <br />At <br />vl <br />c r -v <br />?,-:N C:iE:K �__ = 578.10/hour (8 bouts Ainimum/. AC:L_ � , 7 <br />= 5626.10 mf ni tnso <br />5 <br />Rl REPAIR -_= Cuart--tan Review b res=: r=ion Irsxc:ions) <br />TANK (.C. As) <br />t <br />?i <br />TANK _:KING RE'AIR .-=_ = 578.101hour (3hours zinimLm/TANK7 I <br />3 TAHKts) X 52r6.0O = <br />S <br />A <br />[I <br />c r --r <br />TANK 2�TROFiT RE?AIR ,� = T3_D0/hoar (3 hours win./.AC:L. .) <br />= 6,1;0 minimm <br />1 S <br />R <br />PIPING REPAIR .'c. = 5;8_10/hour (3 hours ainim=/FAC:LIT") <br />- 4.1D ainimun <br />- � <br />S <br />MI <br />--- SO ..^.0 I I aAUTHC2: _ASE /ALUAT:CN = <br />-RANSF=3 <br />ff <br />S' <br />C: <br />I e C^ __ <br />=NSULTAT:CH =c. = 573.1O/hr 1 I S MPL:NG INS?: .ICN r - <br />= 578..+0/hr <br />Taro auE <br />� s <br />FR OF=T=- USE ONLY <br />- <br />Si+c__?S I CrMPUTER '. I LCC =E I 7[r CSE AMCUNT RE:=IlE7 <br />10E•= +'ICAS-4 I RE iVE] 3Y <br />DATE !E•=I'1E7 <br />I i I i S <br />! <br />- <br />' 23 332 (REVISED <br />