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EAN JCIAaUill COUNTY PuRL1C 'HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> U tx1N6 STOR-kGE TANK PROGRAM - FEE "rSHEET <br /> FACILITY SIT <br /> MAW <br /> FACILITY CONTACT NAl1E <br /> A /! //10/1/ <br /> I FACILITY ACtDRESS SITE PHONE # with AREA CODE <br /> ( STATE TIP =1! # of TANKS: � <br /> TCITY !�//V1V at SITE <br /> A APPLICANT/BILLING/ NAME APPLICANT CONTACT NAME <br /> Pr`�tY� <br /> P <br /> L <br /> I NAILING ADDRESS APPLICANT PHONE R WITH AREA CODE <br /> c SZV L>`A97�aj %filo Z q SZ `' S3 <br /> A <br /> N CITY ST(YTE ZIP CODE TYPE of APrLIrATION <br /> CLOSLRE, INSTALLATION, ate. <br /> TOTAL <br /> A <br /> C 1986 1987 1988 1989 1940 <br /> T ANNUAL FACILITY FEE (Prior to 1anmry 1, 1991) !100.00 <br /> 1 ! <br /> v <br /> E TANK FEE _ 150.00/TANK (prior to January 1,1991) 117T)/TANK (after January 1, 1991) <br /> F R Tanks 1986 1947 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (ruttlply 0 by fee for <br /> C tach year applieable) S <br /> 1 <br /> L STATE "CHARGE • $56.00 each TANK (Due every 5 Years) St+r California H L ! Code, lection 25257 <br /> 1 <br /> T R Tank% - x 556.00 1946 through 1990 1491 through 1996 <br /> T (enter ammnt and year) <br /> PERMANENT CLOSURE (Ramovat or Authorized Ctoaure-ln-Placs) 7A1K I.D. #(a) <br /> C <br /> L CLC"E FEE ■ 253.00 per hour (3 hour* minimm per TANK) # TANK(:) �;?— X !159.00 = f 31 g cc <br /> 0 <br /> S <br /> U 19MORARY CLOSURE (A ore-ttine permit, for review/ineWtiorms) TANK I.D. #(a) <br /> R <br /> E TENP0RART CLOSURE FEE ■ $150.00 tach TANK # TANK(s) X !150.00 = s <br /> P I PLAN CHECK (insta(L. Plan Review i Construction inapaetiotts) TANK I.D. #(s) <br /> L <br /> A <br /> N PIAN CHECK FEE - 153.00 per hour (8 hours minions per Facility) • 2424.00 shinimm <br /> R REPAIR FEE (workplan review L con truction inepectloru) TANK I.D. #(s) <br /> E <br /> P TANK REPAIR FEE • 553.00 per hoer (3 hours ■inlwnNTARK) # TANK(s) X 2159.00 • ! <br /> A <br /> I <br /> R P1PIN0 REPAIR FEE ■ 1153.00 per hour (3 hour ■inlwm per facility ■ *159.00) _ <br /> M TRANSFER FEE ■ 220.00 LIbIm"M IZED RELFASE EVALUATION • 253.00/hr ! <br /> 1 <br /> S <br /> C CO)151)LTATIDN FEE E53.00/hr SAMPLING INSPECTION FEE 133.00/hr 2 <br /> TOTAL DUE <br /> Orf ICE USE ONLY <br /> _"••:.�•,:••••�+��r......":....�...w�+.rn�"+.r.......w"r.....�w.."�w�i�Tww��"i.:wry'��nu�rww�.+w..�rwww�ws..f.........a..wri..���wNan.n�rwrwrw+rw�r <br /> i <br /> a�r..w■..=w s,rawr,w a.h.aw.er�....o a■ahwraair■ataerr■.,.aey oura,.%.�aar*hra aw ah�w■.aasaw area maw aw�r we�•araahe ahe�s�aw Maar tar,a.afiw mea ear awsr�s w <br /> EN 73 02 (REV 4/8/911 ft Pana 11 <br />