Laserfiche WebLink
�Awu 1 ir Lu4d,►L HEALTH D I I CT <br /> "l GROUND STORAGE TANK PROGRAM - FEE WORKSHE <br /> F FACILITYISITE NAME <br /> _ FAC <br /> A ILITY CONTACT NAME <br /> , , <br /> C <br /> I T <br /> L STREET ADDRESS SIZE PHONE 1 WITH ARKA Comm <br /> Y CITY STAT IIP CODE I of Tanks <br /> at Site <br /> A APPLICANTIBILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE 1 WITH AREA cour <br /> C <br /> n <br /> k CITY STAT IIP CODE TYPE of APPLICATION <br /> I GLOtlYII(. INGTALLAIION, ETC. <br /> A FACILITY FEE = $100.00 each SITE ADDRESS per YEAR TOTAL <br /> C 1986 1987 1988 1989 17r; <br /> E TANK FEE a $50.00 each TANK <br /> f 1 Tants - x $50.00 1986 1487 1988 1989 r r <br /> A (multjpfy [-by fee (or <br /> C each rear applicable) <br /> L STATE SURCHARGE = $5G.00 each TANK (see -A HEALTH L SAFETY CODE Sec 15282 for applicability) <br /> T 1 Tanks! x $56.00 19BG 1987 1988 1989 <br /> Y center amount and year) <br /> ETTEMPORARY <br /> ENT CLOSURE (Removal or Closure-in-place) <br /> E FEE = $90.00 each TANK 1 Tanks x 190.00 <br /> - $ <br /> U -- <br /> CLOSURE (Only allowed one time for up to two years) <br /> ARY CLOSURE FEE _ $80.00 each TANK 1 Tanks x 680.00 <br /> $ <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> M PLAN CHECK FEE s $50.00 each SUBMISSION/RESUBMISSION <br /> $ <br /> REPAIR <br /> R TANK REPAIR FEE _ $110.00 each TANK 1 Tanks x (114.00 <br /> E t <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> I <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (when applicable) (when applicable) (when applicable) <br /> F[E = $74.00/hr FEE _ $35.00/hr FEE = $3r.00/hr <br /> TOTAL DUE <br /> arrlcc usF oxer <br /> 101 <br /> I <br /> SWEEPS 1 COMP 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK WASHRCVD BY DATE RECEIVED PERMIT 1 <br /> .- -_ <br /> ' II I I Itl I ' .IIlI I' I fp I n 11 <br />