Laserfiche WebLink
Sari ICAQUIM C=TY IftrC REALTN SERVICES - ENVIMOIWAL HEALIR 0 <br /> c <br /> UMDER=3WSTORAGE TANK PROGW - FF—= WCRXSHEET <br /> FAC: SITE NAME FAC:LITT =XT= NAME <br /> S <br /> I� mu- t <br /> ' 'EPAM1TY AOORESS SC is ?'K.N' E -,&i=1 AREA CME <br /> &� <br /> STATE C: � ZIP CMEI � of iiNKS <br /> A <br /> C R at S!M <br /> P APPL'CANT =MTAG NAME- <br /> Pi APPLICANT/BILLING NAME <br /> Ll C.c-,t\ ��rrr W caC�\tc� <br /> I� <br /> Cj MAILING AOORESS APP°-`i�gAxs ?slG°NE + wli'd AREA CME _ <br /> I >'�ATe ZIP =E YPE of APPLICATION s�� 7a.nTIC <br /> TCITY <br /> f ` I�Y! Cty�S fij , (C:csure. (ns:aLLation, etc.) <br /> C�Y� �c2cr, ftp <br /> =AL <br /> - i986 1987 198$ 19W IWO <br /> ANNUAL FACILITY F=2 (Prior -0 'ar%Orf i, 19917 = Si00_30 <br /> A � XXXX ` XXXX � XXXX ! XJCCL } XaCXX ( 5 XXXXX,YXX <br /> C; r <br /> Tj PAC:LIT"' ?ENAL7 FES ASSESSED (If AGsticaate) CWC f =a =cx XXXX ` =cx S —Jaz= <br /> I' <br /> V 'ANK ?_ = S50.00/TANK (Prior to lanuarf 1,19913 I Sti11/TANK Cater lanraarf T, 1941) 1 <br /> ci 'antis = � 19138 I 1984 ' 1990 ` 1991 I� 1992 � 1993 ' 1994 1995 %I t9 � 1997 � 1998 <br /> F ?auL:ipty by 'or II <br /> xxxx <br /> Al =ac.^l year acpiicact4) =a ( X.YXX =a I =a <br /> C' <br /> (l 'ANK ?E?IALTY FEES ASSESSED' � XXXa I tca ; =cc � :cca ((XX( � � � <br /> IS <br /> L: S <br /> If STATE SURCHARGE FOR NEii FAC,LITIE'a CNL7=S1$.�+1 <br /> T' <br /> Ti = "anKs x 53.00 1988 �rcugn 1993 (556} 1993 rcres:rit 1997 (556)# '998 <br /> i I ==mcccccccc==== S <br /> j <br /> 7-JRC3ARGc FOR 1998 I } tt <br /> Ci ?c?MANE'iT CLOSURE (2emav8t or Autnarfzed Closure-En-?lace? I K I.J. :Ks) I <br /> L __ <br /> al ..rCSURE __ _ <br /> Si$.u'L1/hone' C3 lours a,inimuWTANKI � # TANKCs) X S�6.00 = S <br /> S _ <br /> Ul 'c'!PCRARY CLOSURE (Plan .1eview 3 (nS�.i0m) p TANK I.J. nS) <br /> 2 <br /> 7ZMPCRARY CLCSURE =c_ = S-,8_410/how C3 hours ainimumiFACLITYau <br /> ) f Sc�.6.00 minin S <br /> P ?'-AN ME= (Plan Review S Cas=w.ae.4os insrr.ianslj 'AHK I.J. *(S) 1 <br /> L� <br /> AI <br /> y! ?a�N C:FEa'G Fe_ = sm.J0/ttcur ($ hours airtimualFACiL1i f) = 5b24.00 minimum S <br /> (Sdorkolan Review b Ct:s:ian Inscec.iems) TANK I.J_ TLS) <br /> ?� 'ANK _1?e1NG RE--AIR ;rp = SM.30/hour (3 hours :einieeeusa/TANK) 7ANK(s) X S2.14.M _ S <br /> A , = 6.00 ainimem <br /> II +'ANK 2ETRGFIT REaAIR r = Si3_00/houu' (3 haws ain.lFAC:L.aTY, S=-4..M S <br /> R <br /> ?1PIYG .2E?AtR P'e3 = 578_00/hoar (3 hours ainimean/FAC:LITT) = QT6.00 ainiram S <br /> MI 72ANSFER FEE _ x.00 4 '�AUT'+MI!-- XE=. IALUATICIt = SB_00lhr S I <br /> C, i <br /> C, :„.NSULTAtICIN �� = S78.30/hr � � SAMPLI)IG INSPECTION F.._ = 578.00thr f � <br /> TOTAL m E s <br /> FM OF?IC USE OWL, <br /> C .MPUTER A 6 LCC CSE O(ST CSE AMWNT .tE.,:aVFs7 <br /> ME= :J�. it RE v:�F7 3Y i SATE 2E=. <br /> E3 Z3 332 (REVISC 1-12-418) <br />