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MAR 13 'o'� 14 FET t_)LEUh1 EhIGIhIEE Ih�C,'7 i7S4 T H D 1 S Z C T F
<br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET
<br /> F FACIL� TGA,,NAME..
<br /> ,:»,.,.,-,,..._,.....".,,,..«»_.».,.«,,,«,:,.,.,.:,,,,,,. FACILITY
<br /> CONTACT NAME634^48G0
<br /> M
<br /> "FAST �
<br /> {
<br /> I STR80�DEAS 11WY. 12 SITE PHONE #20 359-3124
<br /> T. ..:,..,n, w,,...w.w..,_.,..: .,.................. ..:.,,:.,..:, ,.,,,,.,,._,,,...... ,,,.. ,o..w..r» n,,, ,.: ,,,,_. ,.n• ,.r .....r..rrx»...wrr. .____ _
<br /> Y 4ITODI uTATE ZIP CODE 1 of Tonka
<br /> ri
<br /> ._A at Si to FOUR
<br /> F APPLICANT/BILLING NAME Y APPLICANT CONTACT NAME
<br /> P PETROLEUM ENGINEERING, INC. MICHELLE DOYLE
<br /> L...........,,...............,:,,.:,_,,,,,,,,,.-,,._,,.,,,,:.,:.,:,,,.,,,.,,._.,..,,-.,,-.,,.,.,..,,_..W,................._...... :,.,:.,...........:,,,.._.._,:,,,,._,....,..,,. ......... ....... . W.
<br /> I (SAILING ADDRESS - YAPPLICANT PHONE I Nt" ARIA ooet
<br /> A, �,,T,: ,iN.YN'TH,.STREET .-.T, 707-545-0360
<br /> N CITY STATE! }ZIP CODEw TYPE of APPLICATION TANK . ..
<br /> .1. ._95401LOSMRE, INITA4UAT14", ETC
<br /> �..•, FAG,TLITY FEE 1•1- 1140.A01-each SITE-ADDRESS�per YEAR�W»�»«.w__,.�.,�w��.___,,._.:._.,_,,._,.__...-.�,._ TOTAL r
<br /> C 1986 1987 Ise$ 1989
<br /> I.1s
<br /> V .._-11-----.-....................._.._..,.,,,.,.._...,_�.,. ,...........,.,,.......,,........
<br /> ,.,,,,.,._,..—_..,
<br /> t 1ANK FEE 2 $50,00 each TANK,
<br /> F, .:Tanks,,,,:,.,,,,,,.,:,ti,,,$SO,Ob._.,,,,,,,,,.,,,,,,,,,,,;,; .,.,,,, 19$6..: „ _14$7,_.:.: ..,....,..,, 19$$,.,..,_, .,_1984.,,,,,... ....___.,.,.,:.:,.,......
<br /> A (multiply"#"by fee for ........, ....»..,,,»,..,,. _.,.»,.,_:,__.,,,__ ........-...
<br /> .._.,_._, _.,...,._._._. .»,. »«.�«........... __..._
<br /> C ea0l year applicable) !
<br /> L STATE SURCHARGE _ 156.00 each TANK (see CA HEALTH & SAFETY CODE Sec 75287 for applicability)
<br /> t .t Tan1;5_ x iS6,Q(� 14$5 19$7 19e$ 198')
<br /> Y (enter amount and year) ..,..._....
<br /> ...........».,.«,, ...................,..,,.._,.,.,.......
<br /> ,,.._,..-,.---
<br /> CPt:RMANENT CLOSURE (Rrnoval_^ar_
<br /> ..Clo9ure-in-place),.....W�W
<br /> O��I.l05URE FI:E;:...LL..:ti�I4,00 each TANKW_...,,_...�_,....,.«»,,..,..,....._.,_,,,_,,.__,,,.,_.,._.,,T•�.., 11 Tan1;5......-.._.,..._z'190�04 ,....� f_«..«.»....«. »,.:,...._.:,.�...,.
<br /> R TEMPORARY CLOSURE (Only alloyed one tine for up to tva years)
<br /> TEMPORARY CLOSURE FEE : !84,00 each TANK # Tanks x 1$0,00 !
<br /> _
<br /> „PPLAN CHECK (Installation or�Repair)
<br /> A
<br /> N PLAN CHECK FEE 4 W.00 each SU9M1551DN/RESUDM1S5fON s
<br /> I REPAIR
<br /> P TANK REPAIR FEEy- 1110,00 each TANK T.. _....................,,.,_......._.-_, # Tanks �..�__-x 1110,00
<br /> .
<br /> A PIPING REPAIR/CLOSURWEMOVAL (Ppea 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 /> FEE3b,00/hr#.,,,,,.u.,,.,.,'Y.,.:_.,.y,,.._«_+._._.FEE�_xx._$35,,.00/hr.�,_,.,....__`,_,... FEE - 135.00/hr,�.-. ....
<br /> TOTAL bUE !
<br /> 4fFICE USE ONiY _,�.,
<br /> "'i4"��"!iii�i{i�t{ui i�lli����i,�,�i�l"1�1�'�1���16I111�1�1p��!II�i l!l�i illlll�lw��1�111I411�1�1�11! �11I11i"d!1�1lI�II�flCg11���1�11�11�1�41��i�1��:11i11�1���17�?li?�f(t��� !nlll�ll{�N, !111�1411��1.�, � , �a ,,,7 I�Ill�ll Ali ; � .i�I i
<br /> ,.. .,,.,.. .,,.,_,....,., ,,. ST CODE A1i0UN1 DUE AMOUNT RCVD CHECK #!CASH RCVD BY DATE RECEIVED PERMIT #
<br /> SWEEPS #
<br /> COMP,..a,.....,,,LOG ODE DI..:........,,.D ...,...... ..............................__..,,,_.._,,,...,._,..,,...,,_,...._..,.:.,,,._,:_,.,:..,.,.,.,,.____.,._W,..__,.ECRL..._..,.._....-,....I.._,- .
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