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04-21-93 11:39AM P1" <br /> SAM JOAWIM coLNTY "LIC ASALTO SERVICES - ENVIROIR@NTAL NFALfN DIVEIgI <br /> UiDERGRMED StOtIArA TANK PROMM • FEE UMKSNEEf <br /> S FACILITY SITE WAKE <br /> FACILITY CONTACT NAME <br /> 1 K.Sr.x am``AiD TrKAVA$Ynl l)C-/ <br /> T SITE PHONE r with AREA CODE <br /> AL E /AGILITY ADDRESS ?xjdj 0141% 5 5(0 9 <br /> + STATE ZIP CCCS r of TANKS <br /> A <br /> C1TT CA at SITE <br /> Sc Cockier 1 a <br /> P APPL)CANT/BILLIMO NAME Tr+e.t�Qf Ckk E�MaVBtUtO� v�''�w4Q% APPLIUNT CONTACT NAME <br /> L t��tltbv1 <br /> I APPLICANT PHONE r WITH AREA CODE <br /> C MAILING ADDRESS -RICO 34g Oa B Q <br /> A 50o G $FYesT -b\4 <br /> M STATE 21P CODE TYPE of APPLICATIONGlu6i.LrG <br /> T CITY aC 9 52.0 1 (Closure, Inststlation, •ee.) <br /> Q�lAtn ��vl TmAL <br /> 1966 1967 1988 1909 . 1990 <br /> ANNUAL FACIU'Y FEE (Prior to JarAlery 1, 1991) $100.00 1C,0 too LDC+ 100 100 f 5m se <br /> A <br /> C rb <br /> T FACILITY PENALTY FEES ASSESSED (If APPII.Bhle) %%%X X1O(% lO0 lOb t6 CD f aQ0 <br /> I 5170/TANK (After Janusry 1, 1991) <br /> V IANK FEE a 150.00/TANK (Prior to lenuery 1,19917 <br /> E 1986 1987 1988 1989 1990 1991 1992 1993 1994 1945 1496 <br /> A 7ankt • #� <br /> F (muttfpty N by tee for i 00 <br /> A each Year Applicable) $d $O $OD SO I-}C l'�D tl0 <br /> C f bbpeo <br /> I TANK PENALTY FESS ASSESSED X%X% %%%% $O 56 So l�D ('7D tZ 0 <br /> L <br /> I STATE SURCHARGE • S56.00 each TANK (Ove every 5 year$) See Call(orn(e M i IF Code, ieeif on 25207 <br /> T 1991 Through 1996 <br /> Y i Tanks I A 536.00 1986 throug'1 +940 <br /> (Enter amount On year) <br /> Scs, Siam f j2ec <br /> C PERMANENT CLOSURE (Removal or Authors Ted Closure-in-Place) TANK 1-0. N(a7 <br /> L $ TANKfa) % 8231.00 • S Z.xy <br /> 0 ft05VRE fEE fTB.DOJheu• (} hours minim.Fr,/IANK) <br /> f <br /> U TEMPORARY C(OSRRE (Plan Review A Inspections) TANK 1.0, N(s) <br /> R <br /> E TEMPORARY CLOSURE FEE • 578.00/hour (3 hours minjm JTANK) N TANKCs), X 123L.00 i <br /> P I9ETALLA1109 PLAN CHECK (Plan Review 8 Consirurtlon InspeCtiVWTANK I.D. a($) <br /> L <br /> A <br /> K PIAN CHECK IEE • 778.00/Hour (D hours ui nfaAAN rACILITT) 7624.00 mintmso f <br /> R REPAIR FEE (Wcrkplm A&VI" A Con#tryellon Pnapect lana) IAuK I-D- #(a) <br /> E s( <br /> P TANK LINING REPAIR FEE • S78.00/Tour 13 hours n4nimim/TANK7 r TANK($) X f234,GD • f Y' <br /> A <br /> I TANK RETRCFTT REPAIR FEE • $78.001hour (3 hour# m1n./FACILI1I) • s734.OD minieFaa S <br /> R <br /> PIPING REPAIR FEE • i79.00/hour 43 hours min(etaJCACILITT7 • S234.00 minims f <br /> N TRANSFER FEE • $2D.D0 UNAUTHORIZED RELEASEE £VALUATION a i78.001hr i <br /> f <br /> S <br /> C LONSVUA7IOH FEE 278.00lhr SANPLIWC INSPECTION FEE - 178.1)9/hr S <br /> TOTAL DUE f as(p(p DO <br /> FOR OFFICE USE ONLY oeNp mOWN <br /> Mm. mnssuci+rim Ram= ieY���M.,li 1IW C' <br /> SWEEPS M 1 COAPVTFR r LOC CME DIST CODE AMOUWI RECEIVED CACtt N/CASA RLCEIVED fY GATE RECEIVED <br /> aan�an;:sz.a.. i6a.aki•atP aacairmG�aacv ._ <br /> EN 23 032 (REVISED 11.1-92) Page 11 <br />