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SAN JOA00IN COUNTY PUBLIC HEALTH SERVICES <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHFET Ir <br /> FACILITY SITE NAME FACILITY CONTACT NAME 1 1990 <br /> F <br /> SITE PHONE # with AREA CODF <br /> I FACILITY ADDRESS �JVIR <br /> T��1M!TisERV1(,F' <br /> I <br /> /3 C' S 3 6 .3 <br /> T CITY / _ STATE ZIP CODE 0 of TANKS <br /> Y ST�C�iG�+9/` 2/4 gc/ga-3 at SITE ---- <br /> A APPLICANT/BILLING NAME APPLICANTCONTACTNAME <br /> P — <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE >Y WITH AREA CODE <br /> �/Gli? .�'oScv.1/P/fir icv a lu.zds G9 9s G p!G - 3 Y8 - 3vs 7 <br /> Z_ <br /> A ' <br /> N CITY STATE ZIP CODE TYPE of APPI ICON- <br /> 12 4 2 <br /> Er :. <br /> w � ; July 18, 1990 <br /> L' p IEER8,INC. i �0 <br /> HA�1� AU�11:N 95821 <br /> AtlWA PIIS <br /> mbuin Blvd. S e S mento,GA <br /> �<�� HEA► <br /> rrt �C�F` <br /> F y PAYPERM <br /> THIS AMO <br /> ttl t DOLLARS <br /> ord6`41 <br /> 1401100ONgAMUD TSH gq RESR UIRED: <br /> rwos yyrw <br /> WE4 WINK i <br /> Co1r � s <br /> 2901 . *AV � <br /> x <br /> P PLAN CHE (Installati or Repair) Lox <br /> L <br /> A 1 <br /> N PLAN CHECK FEE = $30.00 each SUBMISSION/RESUBMISSION (1st 2 hrs. of review) <br /> REPAIR <br /> R TANK REPAIR FEE = $110.00 each SUBMISSION/RESUBMISSION tiY Yanks x 1110.00 1 <br /> F - -- <br /> P <br /> A PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> I <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (when applicable) (when applicable) (when srplicable) - <br /> FEE = $30.00/hr FEE = $35.00/hr FEE _ $35.00/hr 1 <br /> TOTAL DUE 1 <br /> OFFICE USE ONLY <br /> .................................................. <br /> .. ............. . ..................................................................................................................................................................... . <br /> .......... . <br /> iva is i wxe.tee.dee»M«w.eei iee.ia:�.e»�w.Meee►Ha ro.a Me►».eo.�a roe woo..»oa»owe xo.xoae woo xw»eew P»Pa�e�»ooat xw xoon w�e wro xeo»woe x000e xo.xceee»o.woo x0000 xe.beoo.woo�e�eee woe w000a wa xoe»>xo�..,� <br /> Y...... ... ..... ........................ ........................ .............. ..........f..11.................. ..... <br /> wa xw wow nee ww wee wew wee ecce eeew wee wave ew oeeew oeee ww oeie wee ww eew woo»>w wew wee ww eeeew wee wee»wo ioiooe ww ww»eea ww»owe woe iooai eeee www ww wee www we weave eew wew woe eeeeee oeee eooe»eew ww"`� <br /> Ae'T f:N PP.eafE POJ(*"to WWW AW MW WWW km lEm m O WE"mm xg xx PORW Me1f ARROQ�ROAI R30fV A4r6 ffW PROW me%PIAT m PR m mm W-X Am PM P01W A:J V"%tM 1MCi4r NM. R�%W417%%AXE Aetl!R'�4�RQef Ee�Y•�?M C..� k'Y <br /> FII 23 017 (RFV 6/90) ft Pnar, 11 <br />