Laserfiche WebLink
FACILITY/SITE NAME UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> F. <br /> (A, FACILITY CONTACT NAME <br /> L STBEET ADDRESS � � <br /> y <br /> SITE PHONE t Leith Area Code) <br /> Y CITY ` C _ <br /> l ATE IIP CODE 1 of TANK'S <br /> at Site <br /> P APPLICANT/BILIIHG NAME APPLICANT CONTACT NAME N <br /> P <br /> L c t <br /> C MAILING ADDRESS C <br /> A cx� APPLPHO <br /> ICARi NE' (with Area Code) _ <br /> N CITY C ` <br /> T STATE IIP CODE T 1 APPLICATIONz <br /> I ; losure Installation, etc,) <br /> A FACILITY FEE • $100,00 each SITE ADDRESS per YEAR TOTAL <br /> C1986 1987 <br /> T 1988 1989 <br /> I <br /> V $ <br /> E TANK FEE a $50,00 each TANK <br /> F t Tanks x (5) 1986 1387 1988 1989 <br /> A (multipT-1 by lee for <br /> C each year applicable) 1 <br /> I <br /> L <br /> STATE SURCHARGE _ $56,00 each TANK (see CA HEALTH t SAFETY CODE Sec 25287 for applicability) <br /> T t Tanks-_ z 156,D0 1386 1381 1988 1389 <br /> Y (enter amount and year, <br /> $ <br /> IEKPORARY <br /> !CLQq1)!RF (nm!y ;jI0,@d <br /> val or Closure-in-place) <br /> ach TANK t Tanks_ x 190,00 f <br /> +110,ed one tlmo for up to Ivo years) <br /> $80.00 each TANK 1 Tanks z $90.00 f <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> N PLAN CHECK FEE ° 130,00 each SUBMISSION/RESUBMISSION f <br /> REPAIR <br /> R <br /> TANK REPAIR FEE • $110.00 each TANK1 Tanks z $110.00 f <br /> A <br /> R PIPING REPAIR/CLO6URWENOVAL (fats are par Iv.,r mloleum one hour to oe paid on plan submittal) <br /> UNAUTHOR17ED RELEASE EVALUATION CONSTRUCTION ) ,. SAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE - 130,00/hr FEE • $35,00/hr EEE = f35A0/hr $ <br /> TOTAL DUE f <br /> OFFICE USE ONLY <br /> SWEEPS t COMP 1 LOC CODEJOIST CODE I AMOUNT DUE I AMOUNT RCVD CHECK WASH I RCVD BY I DATE RECEIVED IPERMIT 1 <br />