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SAN JCACUIN CDLXTY PUBLIC WALT, SERVICES - WIRGRFYTAL REALTH DLVSIcN <br /> LMERWM= STORAGE TANK PROGRAN - FEE LtRYSNEET <br /> RT <br /> FAC: TY SITE NAME D' FA ILITY 6)gft s�i iii [ . 0 0 u t <br /> SIT PHONE 0 with AREA CODE <br /> FACILITY ADDRESS 2� <br /> s (as'oS n71l"�,-rn���.,D1�Su�NrFlt, D�-• p9,At !! <br /> A CITY _�1-K-1 Ck Cr,�'*� a at SITE TE ZIP CODE 0 of o KS <br /> P APPLICANT CO T CT NAME <br /> P APPL CANT/BILLING NAME Tztei <br /> L u Ld <br /> I A LI UNT HONE k WITH AREA CCOE <br /> C MAILING ADORES ^w.� <br /> A 12js G f <br /> N <br /> �Td S�TAJE 7,fjP CODE TYPE of APPLICATION <br /> T CITY ( GjS 7�S" (Closure, Installation, etc.) <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = 5100.00 S <br /> A <br /> G XXXX XXXX S <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) <br /> I <br /> VI TANK FEE = 550.00/TANK (Prior to January 1,1991) 5170/TANK (After January 1, 1991) <br /> E 4 Tanks = 1986 1987 11988 1989 1990 1991 1992 1993 1994 11995 11996 <br /> F (muLciply by tee for I S <br /> A each year applicable) <br /> C S <br /> I TANK PENALTY FEES ASSESSED I %XXX XXXX <br /> [ STA-.E SURCHARGE = S56.00 each TANK (Due every 5 years) 522 California H 3 $ Code, section 25297 <br /> T <br /> YIC ranks_ z $56.00 1986 through 1990 1991 chrou9h 1996 <br /> (Erc:r Z=unc a.- Year) S <br /> I <br /> C, RE.RMA.NE.Vi CLOSURE (Removal or Authari:ed Closure-in-?lace) I TANK I.O. +(s) <br /> L; ~ <br /> 01 CL"SURE FEE = 573.00/hour (3 hours minimum/TANK) 1 TANK(s) _ X 5234.00 - S �y l'f <br /> S' <br /> U TEP?CHARY CCSORE (Plan Review 3 Inspections) TANK I.D. =(s) <br /> Ri _ <br /> vel TEMPCRARY CLCSUR-c FEE = 573.00/hcur (3 hours minimum/TANK) X iANK(5)_ X 5234.00 - S <br /> P INSTALLATION ?LAN CHECK (Plan Review 3 CcnS:ruc Licn InspecLicns) TANK I.D. 0(5) <br /> L <br /> A S <br /> N ?LAN CHECK FEE = S79.00/hour (8 hours minimum/FACILITY) = 5624.00 minimum <br /> R REPAIR FEE (Workplan Review S Canstrxtion InspeCtiorvs) TANK I.D. :(S) <br /> P TANK LINING RE?AIR FEE = 578.00/hour (3 hours minimm/TANK) I Y TANK(s) _ X $234.00 S <br /> A = 5234.00 minimum S <br /> I TANK RETROFIT REPAIR FEE = 573.00/hour (3 hours min./FACILITY) <br /> R5 <br /> PIP(NG REPAIR FEE = 579.00/hour (3 hours minimus/FACILITY) v 5234.00 minimum <br /> M TRANSFER FEE = 520.00 I UNAUTHORIZED RELEASE EVALUATION = 578.00/hr S <br /> II <br /> S 5 <br /> CI CCNSULTATICN FEE 578.001hr SAMPLING INSPECTION FEE - S78.0 /hr <br /> TOTAL DUE S <br /> ( OFFICE USE CULT <br /> S:E ?S X COMPUTER 9 LCC CSE DIST CODE I AMOUNT RECEIVED I CHECX A/USN RECEIVED 9Y DATE RECEIVED <br /> S <br /> E9 Z3 3.32 (REVISED 11-1-92) Page 11 <br />