Laserfiche WebLink
FACILITY NAME <br />FACILITY CONTACT NAME <br />G elf It -- Ivy <br />ra w PI` j /A®r <br />maI <br />APPLICANT PHONE #WITH AREA CODE <br />FACILITY ADDRESS <br />SITE PHONE # WITH AREA CODE <br />� 7�-Tr 2 C v Vd <br />f 3 E— -7 t� <br />CITY STATE <br />ZIP CODE # OF TANKS AT SITE <br />r� C ICA <br />5376 <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />G elf It -- Ivy <br />ra w PI` j /A®r <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE #WITH AREA CODE <br />TEMPORARY CLOSURE FEE = $279 / FACILITY <br />17 0'K 1 <br />CITY I STATE <br />($no) x (#tanks) <br />ZIP CODE <br />CIRCLE WORK TO BE DONE: <br />Closure Installation RepairRet ofl <br />® �® ®(� <br />-7 <br />6 '� <br />ACTIVE FACILITY <br />TANK ID # (s): <br />CLOSURE FEE = $279 / TANK <br />1998 <br />1999 <br />2000 <br />TEMPORARY CLOSURE FEE = $279 / FACILITY <br />2002 2003 <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK <br />($no) x (#tanks) <br />($no) x ( ) <br />$ <br />12001 <br />$125 PER TANK AFTER FIRST TANK <br />SAMPLING INSPECTION FEE _ $ 93/ HOUR <br />$ <br />TANK PENALTY ASSESSED <br />$ <br />TANK SURCHARGE = $10 / TANK <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A COPA PROGRAM =$17.50/ FACILITY is <br />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # (s): <br />CLOSURE FEE = $279 / TANK <br /># TANKS X $279 = <br />TEMPORARY CLOSURE <br />Plan Review and Inspections) <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = $279 / FACILITY <br />REPAIR PLAN CHECK <br />TANK ID # (a): <br />TANK RETROFIT REPAIR FEE = $279 / FACILITY use for monitoring equipment, spill buckets, tank sumps, misc. <br />$ l <br />PIPING REPAIR FEE = $279 / FACILITY use for piping, under -dispenser containment, act. <br />$ <br />MISCELLANEOUS <br />$ <br />TRANSFER FEE _ $ 20 <br />$ <br />CONSULTATION FEE _ $ 93/ HOUR <br />$ <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR <br />$ <br />SAMPLING INSPECTION FEE _ $ 93/ HOUR <br />m" rcr0 Mmr- onacu VIM I rsc aw 99NumL7 RA I C. 1 imt I MA 1 EXCE O Ftt:5 PAID WILL BE BILLED TO APPLICANT. <br />