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SO JOAQUIN LOCAL HEALTI-I *STRICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> F FACILITY/SITE NAME FACILITY CONTACT NAME <br /> A <br /> f <br /> L STREET ADDRESS / SITE PHONE 1 WITH Aa[A 9999 <br /> Y CITY STATE IIP CODE i of Tanks <br /> LAVo at Site �� . <br /> /BILLING NAME LLICANT CONTACT NAME-- <br /> DDRESS ,I LICANT PHONE 1 WITH A9[A 9099 <br /> I L A I d.. ..YS�. r' STAT ZIPC0DE TYPE of APPLICATION--_ — 9L99YA[. IIq TALMT(9N. [TC. <br /> FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR TOTAL <br /> A -_ --- —_._..— - --- _ -. ........ - -._...._...-.- -- <br /> C 986 -1987 1988 1989 <br /> T <br /> v f O <br /> E TANK FEE = $50.00 each TANK <br /> _.- — - - <br /> F t Tanks ( z $50.00 1986 1981Eiii <br /> 1989A fmultipfy-I-by fee for <br /> L Tach year applicable) <br /> —'—�� �0 <br /> STATE SURCHARGE - $56.00 each TANK (see CA HEALTH h SAFETY CODE Sec 25281117 for applicabilzty)�� <br /> I - — _ <br /> T 1 Tanks $56.00 19861981 1988 1989 <br /> Y (enter aiount and year _ <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) -- <br /> L -- ------- - - <br /> 0 CLOSURE FEE _ $90.00 each TANK 1 Tanks <br /> __ 1_ x $90.00 $ <br /> __ <br /> go <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> E TEMPORARY CLOSURE FEE _ $80.00 each TANK 1 Tanks x $80.00 f <br /> P PLAN CHECK (Installation or Repair) - - — <br /> A -- <br /> N PLAN CHECK FEE - $30.00 each SUBMISSION/RESUBMISSION 0 <br /> - REPAIR _--- <br /> R TANK REPAIR FEE o $110.00 each TANK 1 Tanks x $110.00 f <br /> E - ---- ------ _ <br /> p ...-._— - -- -- - ------ — <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minieum one hour to be paid on plan submittal) <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (when applicable) (when applicable) (when applicable) <br /> FEE [ $30.00/hr <br /> FEE _ $35.00/hr _ - - - FEE <br /> TOTAL DUE t <br /> OFFICE USE ONLY <br /> 1 —_ AIATIiAllli'il01MAAtlIViABAA811VIIN VSA Nll�llt�l1@GA'�� <br /> WIN I <br /> D BY DATE P,ECEIVED PERMIT 1 <br /> SWEEPS t COMP I IOC �C�ODE DIS ODE'A� �A�p�E� �AMOOOT R!�VIIA VACHIAIfiIAuGVI/CASHAB� A�RCv _ECEIY -------------- <br /> i � y <br /> AA7�� k '" � P �L&"rAl�l, �I N9�RflaC�u!IiI!AuAOI�A�I II P:Wi,I Ila ��muu IlAaua m�s�Ar uAl A�1�9� 1!SAA I�I�IM�IIu18�14UnpI�AAAII IIIVVk i��N a GAI(� <br />