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+; - SAN JUAQJIN DLIIITT PIALIC REALIN SERVIC95 <br /> EM'1fIROWNTAL NEALTH DIVISION <br /> I" STORAGE TANK PROCRAI( - FEE Ud1KSHEET db <br /> :9179 UN FACILITY CONtAC MAIC <br /> MILITY ADDRESS SITS PHONE 6 Kith AVA ewe <br /> f <br /> 7y/ Z�j 3? -bBc�S <br /> T CITY STAT! lip CODE A of TANK$ <br /> Y St SITE <br /> A APPLICANT/TILLING MAIZE APPLICANT CONTACT NAM! <br /> P C,0 Cil? !} �7�'��1�G 773 A.) <br /> I NAILING ADD Mn APPLICANT PWX1 • UITN AREA CODE <br /> C If A <br /> R CITY ��✓11,,1�' $Tfit 1��i TYPE of APPLICATION <br /> T ( CLOSME, INSTALLATION, etc. <br /> TOTAL <br /> A <br /> C 1486 1947 19" 190 1940 <br /> T ANNUAL FACILITY FEE (Prior to Jexxlal'y 1, 1991) a 1100.00 <br /> T ! <br /> V <br /> E TANK FEE • $50.00/TANK (prior to Jantiery 1,1991) 5170/TANK (after Jamiary 1, t941) <br /> F 0 Tark! ■ 1968 1987 1488 1989 1990 1991 1992 1493 1996 1943 1996 <br /> A (multiply F W fee for <br /> C each year applicable) ! <br /> I <br /> L STATE MACNAROE w !96.00 eacfi TANK (Due every 9 years) I" CallfornIa M ! S Cade, faction 23291 <br /> I <br /> T / Tanka R $36.00 1486 through 1990. 1991 through 19% <br /> T (enter owe t and year) <br /> ! <br /> PERMUINENT CLOSURE (Rmoval or Authorltod Claeure-lm-►lee*) TANK I.D. /(e) <br /> C <br /> L CLOSURE FEE a 253.00 per hour (3 hours ea1n1wA per TANK) 8 TANK(6)-. __ I( 1139.00 <br /> 0 <br /> u TEMPORARY CLOSIAS (A wo-time permit, for reyloWWpoestlons) TANS( I.D. #(a) <br /> R <br /> LIEW-OWY CLOSURI FEE a St5d.00 *eeh tANI( I TANK(a) X $130.00 • ! <br /> P PLJLN CHICK (1rMt 7 Plan Ravi: Z =trta:tlan InspeetloTle) TANK 1.0. i(a) <br /> I. <br /> A <br /> R PUN CHECK FEE - 153.00 par hoe* (I howl Mint" per Feelllty) a u24.00 Minimum <br /> R REPAIR FEC (workplan review 6 coFwtrm lon (nlpeetiom) YANK I.D. 1($) <br /> E <br /> P TANK REPAIR FEE a 153.00 per hart (3 hours INnlaWtANK) 0 TANK(e) X !1+39.00 a ! <br /> A <br /> I <br /> R PIPING REPAIR FEE a $53.00 per hour (3 hour arinloA per feclIIty a SIS9.00) ! <br /> N TRAMIFEA FEE ■ 920.00 UIIAUTN(RIZED ffELEAt1E !VALUATION • 153.00/hr 1 <br /> C CONSULTATION FEE a $53.0O1ht SAMPLING INSPEClow PEE • SS3.00/hr ! <br /> TOTAL DU11 ! <br /> � <br /> OFFICE USE ONLY 1 <br /> w•••••,••y:�...wr..►w........w...eww�nww«�..w....�iw'�www.w.n+w+wfw'}►w�..r+"'1+ iw:.►r�i �"'n`.�`ww..w"i""�i +��n7��«w>� �. nwi...,..iws <br /> ...w..w»....�.www.wiw►ww»niir..�ii�Tiw74wTwiww�i�suoSwi�wrw» �w "'iii'ifiiwiw�aMrrw.�rw�n?wnw.iiiww �iww9M+wiw.Mww s�w�..r�.. <br /> ..�wrwiiw�wrfrMrmwnlafAlYrNwwww,/nweMMIM+w� MMM au�wlsrwwlta�IMl�rrrwrl�MwasiwwwwwoiwlrwlMilrr�wirwMr�nMarroniM�rrMr�tlwrwlwwswwMwrrrirw <br />