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SAN IW COUNTY <br /> JOAENVIRONNEN7ALPUBLIC SERVICES <br /> HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT MAMEG a 1/1pA7-,AQ"C� ✓< <br /> C SITE PHONE Alwith AREA C E_ <br /> 1 FACILITY ADDRESS ./ <br /> T CI7y � ST TE ZIP CODEY of TANKS <br /> Y �. --2 ■t sltE <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P — T <br /> 1 <br /> APPLICANT PHONE IF WITH AREA CODE LING y2QKESS C <br /> W <br /> TaG E P CODE TYPE of APPLICAt10N <br /> 7 � .O � CLOSURE, INSTALIAT ION, etc. v-,a} <br /> TOTAL_ <br /> A -- 1986 1987 1988 1989 1990 <br /> C <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) • 5100.00 — ------- <br /> I f <br /> V <br /> E TANK FEE • $50.00/TANK (prior to January 1,1991) $170/TANK (after January 1, 1991) <br /> f s Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 -- <br /> A (multiply feel for -- - <br /> C each year app $ <br /> tj STATE SURCHARGE $56.00 each TANK (Due wary 5 years) fee California N $ i Code, Section 25287 <br /> I <br /> T N Tanks_ x (56.00 1986 through 1990 1991 through 1996 <br /> T (enter 90 nt and year) <br /> PERMANENT CLOSURE (ReRnval or Authorized Closure-in-Plece) TANK I.D. ka) - <br /> C <br /> L CLOSURE FEE • $53.00 per hour (3 hours mini nw per TANK) Y TANK(s) X $159.00 • i <br /> 0 <br /> U TEMPORARY CLOSURE (A one-time permit, for review/Inspections) TAMC I.D. <br /> E TEMPORARY CLOSURE FEE • $150.00 each TANK 9 TANK(s) X $150.00 • f J v <br /> =AAL tall Plan Revive S Construction Irspectlans) TAMC I.D. i(a) _--- -~� <br /> - $53.00 per hour (8 hours minimum per Facility) • $424.00 minimum 3 <br /> R REPAIR FEE (workplan review S construction impactions) TAMC LD. #(a) <br /> — <br /> E <br /> P TANK REPAIR FEE • $53.00 per hoar (3 hours mininam/TANK) y TANK(s) X $159.00 • _1 f <br /> A <br /> R PIPING REPAIR FEE • $53.00 per hour (3 hour mining per facility • $159.00) $ ._... <br /> M TRANSFER FEE • 520.00 UNAUTNORI2ED RELEASE EVALUATION • $53.00/hr <br /> C CONSULTATION FEE $53.00/hr LMIPLING INSPECTION FEE • $53.00/hr f Y_ <br /> l�)) FF [f�� 1111LLFF pN11 / TOTAL DUE 3 <br /> 'I�gi�MUJm ET. uma4TIC1 muuuuu vmu wouulc iXxum ul mmunlXnnu mlutlu uuuwWJu <br /> iww mww <br /> t �I u� ul'w+-.malaw w i <br /> " �'�"Y o W� is1�4'E REZIENUFD <br /> L � u 1�111ft�11T1 <br /> Wmm W.JiWa <br /> Eli 23 032 (Revised 4/8/91) Page 11 <br />