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SAN J n- Atl I N LGI AL 1-I EALTI-i DIS-fi<, I r .T
<br /> ' U!Il)ER a STO;PiGE TANK PROGRAM FELE P-Mi,,SHEET -
<br /> .....l .........
<br /> F;,CILiTY c:01ITACT NA'1E
<br /> T FAC;L.`.TYISiTE NAME
<br /> meT6�'c ` E(zvtCL INC-
<br /> WITH
<br /> NC ,
<br /> i Q. SITE PYOi9E k u i Tri AREA CODE
<br /> L STREET ADDRESS _
<br /> [ 4 AL1 . � _
<br /> I,_... ...
<br /> 1�"i !,._............ _.._._... -
<br /> 'Y CITY S[ATLI ZIP 1 DE 1 02 T n};5
<br /> • ,-�,� ak Si k
<br /> P
<br /> __.................. ................ ..__._.-:`- .......
<br /> �A APPLICANWBILLING NAME I AFDLIs A0 C0HTh'T TIME
<br /> F ` i 1 LIPM fie: ;Sic 1�,
<br /> i1MAILIN13 ADDRESS APPLICANT PHONE f a'r, AREA CODE
<br /> �I
<br /> r; CITY T��� ZIP 1DE M , ,af APFLICt,rcOh
<br /> I`STALLAT:GN, rTo, t7:a tJY�wL:� I
<br /> ..__._. __...................._. _ ......_..__....-_........
<br /> ..........._.... - - —--
<br /> FAC[I IT'{ FEE = $100,06 cru sa h SITE i DNR S perNI, TOTAL
<br /> � 14
<br /> r .............. _.._-_...._.....__.,..__-_.-. �_..._.-._._._._- __.I__._.:_._.__.-
<br /> rI �
<br /> ,r��r'
<br /> .. F FELE _� 50,00 each TANK
<br /> Fit Tarnk5 x $50 0 1 40 11 E'�
<br /> A; fculllpTy- -hy dee frac _...._._ ._. _....__ ..... ------ --.�__�_..-
<br /> C each year applicable) ++ 4
<br /> LST' ATE SURNAUE _ `''6.00 eacli TAM, (see CA HEALTH !i SAFETY "ODE Set '21`01 f._r
<br /> a,plir.a�bil:ky)
<br /> 1 31
<br /> T�f ianr;sc $.,,�,tsc;�--�-�-------__....--�-�--�,����---�--..__... ___�_��.� ....._._.._-. ._1�3F1S_.._..__....._.........---.....----...._-,---------------• ---
<br /> =D . —
<br /> Y (enter mount and year) __....__.............._-..._...----.-.--......_....-_._.... .._._. .._.._..._._._.._. ..._.___._.._
<br /> ff
<br /> _..._..__........ ..__......................
<br /> C Ft NNENT CLOS IPE (Re3CY.1 or Closure-in-plate) ^�
<br /> --_ — - - .. ---.....
<br /> ---
<br /> D CLOSURE FEE = 490,40 eaeh TAN f 1 x k30 '0
<br /> C ,_ ._._.....- _ - —_._._.______._.._ __--,,-1--,,1",,11. ---
<br /> 1 U .._--.—_—. _..,.__.....__.......,...v ...._.- ...., w......... .....—.- ........_...................
<br /> .
<br /> v {
<br /> 'P. TEMPORARY CLOSURE (Only Adrouec one �t f��r up to No years)
<br /> __...__._. _...........,_._..._....._...___..._..._.__...........__.
<br /> TEMPORARY CLOSURE FEE - 180,00 est, , TAN: k Tanl 5 t GOO c)r 5
<br /> -------------- ...........................__........_._._...__..__._.....---.....:._._......_.._._..._....._..._........-_..........._--.__.,.__._.____
<br /> 'P PLAN Clrr .
<br /> ��";K (1n51allak!on c; Rcpr:;r) �
<br /> L ----�_... _—_-- — _..._._..._..._.._........._.._..........._...............__...,..__...._.__.......... .....,.__,_.................._._..._....,......._....._.._._
<br /> fll PLAN CIdECI: FEE €317,(c0 each SLE° ISS1O,(IRES1OHI 5[Lll S
<br /> IfEP IR °
<br /> £ TANK REPAIR. FEE = 4llr?,00 can c VeK
<br /> A PIPING REPAIR/i-;0SURE,'REMOVAL (Fus ire per hour, �rrri�ra�rr ur e hiiu- to l on plan subxit6.21)
<br /> Ia _ _ - ----.- --—- -- .._. - : -,_ _ """ _ -.. .. ----
<br /> R UNAMORIZER RELEASE EYALIIATIO,N i CONSTRUMON INSF CTIO'� rl,'`EP(ECT 10N
<br /> ( hen applicable) applicaLle) ,icaLle) I
<br /> ___._. ---------- ------
<br /> Ftk - 3^€.,4('fhr� FEE. 7uw.c�c,lrl� I
<br /> . ...:..__... _ ._.
<br /> OFFICE USE OKY
<br /> pnrn n rr hninqup f is , �,r .. ., ii iti". ,...n �lrr� r " r in rF ,� F
<br /> r:,IEL<Ihl,ulluc..,., Ir,irrCr..rV, � iX11T['f�Lea . 1
<br /> q' t!
<br /> S,�E.PS i Game LLOP, CDDE� DIST ���r� IMGE�"!T. DUE �� PEIr:T
<br /> /0 � 2,6
<br />
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