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SAOACUIN CCUNTY PUBLIC HEALTH SERVICES ;29 <br /> ENVIRCNHENTAL HEALTH O1VISICN <br /> Umo ERGRCUND STORAGE TANK PRCGPA4 FEE woRXSHEET <br /> FACILITY CONTACT NAME <br /> FACILITY SITE NAME <br /> A <br /> C SITE PHONE x with AREA CCOE <br /> I FACILITY ADDRESS ff0� �_ y $v v <br /> L �� �1(7 �WY vZb <br /> I ISTATE IIP CODE of TANKS <br /> T CITY ` `� _ I /1 (� a 3 6 at SITE <br /> Y L. C/ry 1. _I <br /> APPLICANT CONTACT NAME <br /> A APPLI�G�ADO�ESS <br /> NT/BILLING NAME <br /> P <br /> L APPLICANT PHONE # WITH -AREA CODE <br /> I AAILIN` �C _ 9 } — L) &'0 ID <br /> It � <br /> A STATE ZIP CODE �YP5a# APCITY LCRf INS7ALLATICN etc- <br /> E !� TOTAL <br /> p 1986 1987 1988 1989 1990 <br /> C <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) = $100.00 S <br /> 1 <br /> VS170/TANK (after January 1, 19413 <br /> E TANK FEE 550.00/TANK (Prior to January 1,1941) <br /> F Tanks = 1986 1987 1988 1989 1990 1491 1492 1993 1994 1995 1996 <br /> A (multiply a by fee for S <br /> C each year applicable) <br /> 1 <br /> L STATE SURCHARGE = 556.00 each TANK (Due every 5 years) See California H b S Code, Section 2528 <br /> I1986 through 1990 1491 through 1996 <br /> T » Tanks x 556.00 <br /> Y (enter amocnt and year) S <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-place) TANK I.O. (s) <br /> C X $159.00 = S <br /> L CLOSURE FEE - $53.00 per hour (3 hours minimum per TANK) TANK(s) <br /> 0 <br /> s <br /> U TENPWRT CLOSURE (A one-time permit, for review b inspections TANK I.D. s <br /> R ° TANK(S) X S150.00 = S <br /> E TEHPCRARY CLOSURE FEE 5150.00 each TANK <br /> R PLAN CHECK (install. Plan Review b Construction Inspections) TANK I.D. {s) <br /> L <br /> A5424.00 minimum <br /> N PLAN CHECK FEE - S53.00 per hour (8 hours minimum per Facility) = <br /> TANK I.D. I($) <br /> R REPAIR <br /> E TANK(s) X 5159.00 S <br /> P TANK REPAIR FEE = S53.00 per hour (3 hours minin V TANK) <br /> A <br /> lS <br /> 0. PIPING REPAIR REVIEW b CONSTRUCTION = 553.00 per hour (3 hour minimum per facility = 5159.00) <br /> N CCNSULTATIONS UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> S FEE 153.00/hr FEE S 53.00/" <br /> C FEE = 553.40/hr <br /> TOTAL DUE S <br /> OFFICE USE ONLY ?� <br /> J.:• <br /> ................... ......... ■r: u• _i Y,• •. -i 4 x n -. Y .. a �,? .••e.e.•r T '�:.j C. •"r' t ws u�i�• 1'1Ii +09 <br /> ..... .... ........ , i s:.xs .. '_; cI iEO n s <br /> cs�T --' �r�►s��x�'°' GC" CCOE��,- ��I ST�CCL)e � d]lC'�NT"ZC"vty" I Crie_.0 �ICxSri <br /> �.c_75 <br />