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- �4� <br /> /f f <br /> Ott' <br /> .��►�' � �q �� N�p,+�P��f a. s;-rte IL <br /> COUNTY <br /> � TOKENTAL HEALTH DIVISIONVICE4 <br /> AMK PROGRAM FEE WORKSHEET <br /> FAC ITB Si TE <br /> A� S' Li4 V�a�,� FACILITY CONTACT NAME <br /> a. L . /v�t sL,.! .ao <I SS Soj U <br /> L FACT ITY ADDRESS SITE PHONE g with &REA COD <br /> T CIT 7STATE <br /> CODE NI of TANKS <br /> Y ��'�-'�"� acs at SITE <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P �anlKS �' (r.D <br /> I NAILING ADDRESS APPLICANT PHOk 0 WITH AREA CODE <br /> A L►k - <br /> v9 8 s'-3y Sera <br /> N CITY r� �/ D CODE TYPE of APPLICATION <br /> T '7 CLOSURE, INSTALLATION, etc. <br /> A TOTAL <br /> I ANNUAL FACILITY FEE (Prior to January 1, 1991) ■ $100.00 1986 1987 1988 1989 1990 <br /> $ <br /> E TANK FEF ■ S50.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F ( Tanks a 1986 1987 198$ 1989 1990 1991 1992 1993 1996 1995 1996 <br /> 'A (multiply &MIlcoe for <br /> each year app $cable) $ <br /> L !TATE SURCHARGE ■ 556.00 each TANK (Due every 5 years) See.California H IG S Code, Section 25287 <br /> Y (enters=Mtxand year) 1986 through 1990 1941 through 1996 <br /> s <br /> C <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. /(a) <br /> L CLOSURE FEE ■ $53.00 per hour (3 hours minimm per TANK) 1 TANK(s} i X S}g4;00 ■ S 6 6 <br /> a - <br /> S <br /> R TEMPORARY CLOSURE (A one-time permit, for review/Inspect long) TAMC I.D. #(a) <br /> E TEMPORARY CLOSURE FEE a S150.DO each TANK 0 TANK($) X f150.00 ■ g <br /> P PLAN CHECK (Irotall. Plan Review i Construction Inspections) TANgC i.0. #(s) <br /> L <br /> A <br /> N PLAN CHECK FEE - $53.00 per hour (8 hour$ minimum per Facility) a $426.00 minimum = <br /> R REPAIR FEE (INorkplsn rwlaw Z construction inspections) TAMIC I.b. <br /> E 1T(a) <br /> P TANK REPAIR FEE ■ 153.00 per hour (3 hours minimWTANK) ! TANK(@) X $159.00 ■ $ <br /> A <br /> I <br /> R PIPING REPAIR FEE ■ $53.00 per hour (3 hour minimum per facility ■ $159.00) S <br /> H TRANSFER FEE ■ S20.00 UNAUTHORIZED RELEASE EVALUATION ■ 153.00/hr $ <br /> S <br /> C CONSULTATION FEE a $53.00/hr SAMPLING INSPECTION FEE ■ 553.00/hr : <br /> e /)C Z� TOTAL DUEgo—OFFICE USF Owly f � <br /> f"V ILI <br /> L' <br /> ZZ <br /> EN 23 02 MOV I•ad Z18Ij91) Page 11 <br />