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• ..,ti ., V i-1...c..� i.y L_...,+.M L r-1 tW r A L I n L 113 i K L o- I <br /> *RGROUND STORAGE TANK PROGRAM - FEE WORKSHf <br /> €fIFACILI-TY/SITE NAME (FACILITY CONTACT NAME <br /> '' <br /> 'C d'Co rjWoo D Kok-o rJ <br /> L STREET ADDRESS SITE PHONE I WITH AREA CODE <br /> Y CITY STATE IIP CODE I of Tan>;s <br /> S�aGK-r�Ani.. C 9�aZ a" at Site <br /> A APPLICANTIAILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P 'W0L1'nI .t SOnl S INC- /KT KvRonl <br /> L........... <br /> ----..._..__...._...__._._..... <br /> I MAILING ADDRESS APPLICANT PHONE I WITH AREA CODE -- <br /> N CITY STAGE ZIP CODE TYPE of APPLICATION <br /> T S U-T TEV C2�K c{f <br /> • RCLOHURE. [NBTALLA7ION, ETC. o1/tlL <br /> •FAL.ILITY FEE•�^..s-IOO.YOO...each SITE-ADDRESS per YEAR TOTAL <br /> .__....__.-.._._..Y......_........ <br /> _ --._..__...._._......_....._...... ..._._._._...._.....-......_...._..._._._..._..------- .._......__..._..----_._..._._.__._ . <br /> 1986 1987 1988 1983 <br /> E TANK FEE = $50.00 each TANK, <br /> _1........_...._................... <br /> x #50.00. . _..._.._...19...................... _._........._...._...__.._.... ....................__..._.............. <br /> ........ <br /> ._...... <br /> - - ---_- -..._...__.._.._..... <br /> ........ <br /> ............ <br /> ..... <br /> ... <br /> F I Tanks 86 1987 1988 1989 <br /> A (mu l t i p ly f b y fee for <br /> C each year applicable) # <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH k SAFETY CODE Set 25287 for applicability) <br /> T I Tanks x (56.00 1986 1987 1988 1983 -- _-_T_- <br /> Y (enter amount and year) <br /> -............................. <br /> ._.__._ <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L -- ..._._..........._._._...._......_...._........___- -_ ...__..___ ------- - ----_ _ -_ . - f _ <br /> 0 CLOSURE FEE = $30.00 each TANK I Tanks ,--x $90,00 �g oG <br /> - <br /> S...-------- _. -- ----_. __ __-- -----_._._.._...-- ---—_.—_ ..—__- _-.-. _�---- <br /> U ..._..._._... - <br /> R TEMPOP.ARY CLOSURE (Only al oved one time for up to two years) <br /> TEMPORARY CLOSURE FEE = ,0�► ach TANK I Tanks <br /> x $80.00 $ <br /> ..,_..._._.._.__.___._.... _ <br /> P PLAN CHECK llat�� Repai�'1�r___ ._-.._.---����_.--•--�_-.---__.__-- <br /> L._._....._._..__...._.. ...-___.. <br /> A AJ''qq <br /> [N PLAN-CHECK FEE - each 9ISSION/RESUBMISSION $ <br /> ..........__ _ .._...._.........._..... <br /> REPAIR L/ F <br /> ...._._-----•---- <br /> E TANK REPAIR FEE = $110.00 each TA �# Tanks x 1110.00 # <br /> -_ - --Y_....._..._....._._----.._ ___ _.. ---- ._...__._.._.........._............_........._......_..._...._......_. ..._...............-....._...._......_...._...._..____...._..--.._... ......_....._..__..._._—._._. __._... . <br /> P................-- -_ _.._............__ ___.._ ._..__._._ ------ _ __._ ----•_ _...___- --___ _ _ --.._ — _- -- <br /> A PIPING REPAIRICLOSURE/P.EMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (when applicable) (when applicable) (when applicable) <br /> FEE - #,0.00/hr _.-_-. ,___ ---- FEE YYµ#3,_04/hr _-.___._-_.----- - -- FEE $35(35.00/hr� <br /> TOTAL DUE <br /> } <br /> OFFICE USE OR[Y <br /> I! 11111110 MME101 BIE01, 1111191101MR1119 MIT"1liMN#I=, 101101 10 UNNlUME1 HR11 11111I1i1IH <br /> a SWEEPS I COMP I LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK I/CASH RCVD BY DATE RECEIVED PERMIT I <br /> .............._-..._........_.................._............_..._._..._............__...........................-...................................................................._....._...__._....__._.... ..._._._ _............. <br /> l � ICT�lPfIIl?Ill� ' f <br /> I 11cI�QI 8 � � Vl� lffl <br />