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a SP",-JOAQU I N LOCAL HEALTH - r"•TR I CT <br /> 4DERGROIIND STORAGE TANK PROGRAM - FEE NORMS let <br /> F FACILITYISITE .NAME FACILITY CONTACT NAME <br /> L STREET ADDRESS' S5-01) <br /> PHONE I (vith ea Code) <br /> -7 0 E_ C.10 CA-t- FIA -7 <br /> Y CITY STATE 21P CODE 1 of TANK'S l <br /> { at Site <br /> A APPLICANT/B11LInn G NAME APPLICANT CONTACT NAME <br /> CISi C S14 <br /> I MAILING ADDRESS O APPLICAYONE I (with Area Code) <br /> A 7 <br /> CITY STATE I CODE TYPE of APPLICATION <br /> PZbU7' (Closure, Installation, etc.) <br /> FACILITY FEE _ $100.00 each SITE-ADDRESS per YEAR TOIAL <br /> A <br /> . C 1986 1987 1988 1989IT <br /> { <br /> E TANK.FEE = 150.00 each TANK <br /> F I Tanks 1 x #50.00 1986 1987 1988 1989 <br /> A (multiplq-II"by fee for <br /> ! each year applicable) ✓ ✓ ` 2,0 U <br /> STATE SURCHARGE = #56.00 each TANK (see CA HEALTH & SAFETY CODE Sec 25287 for applicability) <br /> T I Tanks [__ x $56.00 1996 1987 1988 1989 I <br /> Y tenter 5n"ount and year) <br /> IRMANENT CLOSURE (Remora! or Closure-in-place) T <br /> SURE FEE = #90.00 each TANK I Tanks X. $90.00 $ <br /> PORARY CLDSURE (Only allowed one time for up to two years) <br /> PORARY CLOSURE FEE _ $80,00 each TANK I Tanks x #80.00 $ <br /> P PLAN CHECK (Installation or Repair) <br /> A <br /> H PLAN CHECK FEE _ $30,00 each SUBMISSION/RESUSMISSION $ <br /> .:i <br /> REPAIR <br /> R <br /> E TANK REPAIR FEE _ $110.00 each TANK I Tanks x 51,10.00 $ <br /> P <br /> I PIPING REPAIRICLOSUREIRENOVAL (Fees are per hour, miniaum one hour to be paid on plan submittal) <br /> R ; <br /> UNAUTHORIIED RELEASE EVALUATION CONSTRUCTION SAMPLING <br /> (when applicable) INSPECTION <br /> INSPECTION <br /> FEE = $30.00/hr FEE = #35.001hr FEE = 535.001hr 5 <br /> TOTAL DUE <br /> OF110E UsE PNIr <br /> SWEEPS I COMP I LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK IICASH RCVD SY DATE RECEIVED PERMIT I <br /> '' Mt1'+C°"'ha��'. . .'Mie• .'.�7r!{�,4 { ., ' <br /> z <br />