Laserfiche WebLink
,3 <br />FACILITY SITE NAME <br />FACILITY CONTACT NAME <br />v<_ S/TES <br />SITE PHONE 0 with AREA CODE <br />I <br />FACILITY ADORESS <br />L <br />T <br />C(TY <br />STATE <br />ZIP CODE <br />! of TANKS <br />at SITE <br />Y <br />A <br />APPLICANT/BILLING NAME <br />APPLIC/AN�T CONTACT NAME <br />ANG F /�G <br />/� V 5� <br />APPLICANT PHONE 0 WITH AREA CODE <br />C <br />KAILIW f ORESS, <br />mos <br />A <br />STA E 935 LP CLTY PE of OSIHLE,�NSTALUT�I ON, ate. <br />CITY LP <br />/iIG%J/r _ <br />7-4 14,41 fr1 <br />TOTAL <br />A <br />1986 1987 11988 1989 1990 <br />C <br />T <br />I <br />ANNUAL FACILITY FEE (Prior to January:1, 1991) • 1100.00 <br />1 <br />V <br />E <br />1991) <br />TANK FEE • SSO.00/TANK (prior to January 1,1991) 1170/TANK (after Janary 1, <br />Fl <br />3 Tanks : 11986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br />A <br />(nultiply ifee for <br />t <br />C <br />each year app icable) <br />L <br />STATE SURCHARGE • 156.00 each TANK (Due every 5 years) See California X L S Code, Section 2528 <br />I <br />i <br />s Tanks x $56 1986 through 1990 <br />.00 <br />1991 through 1996 <br />Y <br />(enter amount and year) <br />S <br />PERMANENT CLOSURE (Removal or Authorized Closure-in-PLace) TANK I.D. !(s) <br />C <br />L <br />CLOSURE FEE + 153.00 per hour (3 hours minimum per TANK) Al TANK(s)_ X 5159.00 <br />0 <br />TU5 TEMPORARY CLOSURE (A one-time permit, for review/inspections) TAMC I.D. !(s) <br />z <br />TEMPORARY CLOSURE FEE 2150.00 each TANK ! TANK(s) __ X 1150.00 • <br />P <br />PLAN CHECK (Install. Plan Review L Construction Inspections) TANK I.D. !(s) <br />A <br />NI <br />PLAN CHECK FEE - 553.00 per hour (8 hours mi nimtm per Facility) <br />• f424.00 minimum <br />1 <br />RI <br />REPAIR FEE (workplan review L construction inspections) <br />E <br />7 <br />TANK REPAIR FEE • 153.00 per hour (3 hours minimtMTANK) <br />t TANK(s) !� X 1159.00 • <br />�y v0 <br />5 �_7 Q <br />A <br />R <br />PIPING REPAIR FEE • 153.00 per hour (3 hour mini num per facility <br />• $159.00) <br />t <br />M <br />1 <br />TRANSFER FEE • S20.00 I I UNAUTHORIZED RELEASE EVALUATION • 153.00/hr I <br />t <br />S <br />ClCONSULTATION FEE • S53.00/hr SAMPLING INSPECTION FEE <br />.553.00/hr I <br />5 <br />TOTAL DUE <br />1 qeQ OZ) <br />EH Z3 032 (REV 4/8/91) ft <br />S LC.Ei VEE <br />J U f4 0 5 -S2 <br />SAN ]OAQL:IN COI. 1Nl <br />iJVIRONNIENTAL HEAL H <br />°roac iw is .m..a nu, 1I enc/owro• aro not -- noted, kindly notify u• at once. <br />