COMPLIANCE INFO_1985-1996 - Laserfiche WebLink

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SAN JOA IN COTNITY FtRILIC REALTN SERVICES - ENVIR NTAL TTEALTH DIVSION UA&ROkMSTORATW- TANK rR - FEE KSHEIT♦ 1 FACILITY SITE `NAME_.A , - y FACILITY CONTACT NAME 1988 1989 1990 CLOSURE FEE _ !78.00/hour (3 hours minimtum/TANK) E FACILITY ADDRESS` `tr ,• I ANNUAL FACILITY FEE (Prior to January 1, 1991) _ 1100.00 P PHONE N with AREACm SITE/ 7t�6 R CITY A �/� �(\ �p / n i I $TATE ZIP CODE of TANKS atSITE =� P PPLICANT/BILLING NAME xxxx -- xxxx ---- - APPLICANT CONTACT NAME , TANK RETROFIT REPAIR FEE _ $78.00/hour (3 hours min./FACILITY) = $234.00 minimum $ ! A C MAILING RESS PIPING REPAIR FEE _ $78.00/hour (3 hours minimum/FACILITY) _ $234.00 minimum APPLICANT PHONE R WITH AREA CODE -AD - A D T CITY C STATE ZIP CODE TYPE_of--NPPLICATION (Closure, )Installation, etc.) FACILITY PENALTY FEES ASSESSED (If Applicable) xxxx xxxx $ 1 V TANK FEE = S50.00/TANK (Prior" to January 1,1991) $170/TANK (After January 1, 1991) E TOTAL C PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) 1986 1987 1988 1989 1990 CLOSURE FEE _ !78.00/hour (3 hours minimtum/TANK) — - N TANK (s) X $234.00 $ I_® ANNUAL FACILITY FEE (Prior to January 1, 1991) _ 1100.00 P _ V — U TEMPORARY CLOSURE (Plan Review & Inspections) TANK B.D. N(s) R xxxx -- xxxx I TANK RETROFIT REPAIR FEE _ $78.00/hour (3 hours min./FACILITY) = $234.00 minimum $ ! A N TANK(s) X $234.00 = $ PIPING REPAIR FEE _ $78.00/hour (3 hours minimum/FACILITY) _ $234.00 minimum s — C T FACILITY PENALTY FEES ASSESSED (If Applicable) xxxx xxxx $ 1 V TANK FEE = S50.00/TANK (Prior" to January 1,1991) $170/TANK (After January 1, 1991) E N Tanks = 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 F (multiply N by fee for xxxx xxxx $ A each year applicable) C TANK PENALTY FEES ASSESSED xxxx xxxx 1 s l I STATE SURCHARGE ® 956.00 each TANK (Due every 5 years) See California N A S Code, Section 25287 T X Tanks x 156.00 1988 through 1990 1991 through 1996 (Enter amount and year) $ C PERMANENT CLOSURE (Removal or Authorized Closure -in -Place) TANK I.D. N(a) L O CLOSURE FEE _ !78.00/hour (3 hours minimtum/TANK) — - N TANK (s) X $234.00 $ I_® S P _ V — U TEMPORARY CLOSURE (Plan Review & Inspections) TANK B.D. N(s) R I TANK RETROFIT REPAIR FEE _ $78.00/hour (3 hours min./FACILITY) = $234.00 minimum $ E TEMPORARY CLOSURE FEE _ $78.00/hour (3 hours minimm/TANK) N TANK(s) X $234.00 = $ P INSTALLATION PLAN CHECK (Plan Review t Construction Inspections) TANK B.D. N(s) L A P TANK LINING REPAIR FEE _ $78.00/hour 0 hours minimum/TANK) N PLAN CHECK FEE _ $78.00/hour (8 hours minimum/FACILITY) _ $624.00 minimum $ R REPAIR FEE (Workptan Review R Construction Inspections) TANK I.D. N(s) E P TANK LINING REPAIR FEE _ $78.00/hour 0 hours minimum/TANK) N TANK(s) x $234.00 • $ A I TANK RETROFIT REPAIR FEE _ $78.00/hour (3 hours min./FACILITY) = $234.00 minimum $ R PIPING REPAIR FEE _ $78.00/hour (3 hours minimum/FACILITY) _ $234.00 minimum s M TRANSFER FEE _ $20.00 UNAUTHORIZED RELEASE EVALUATION = $18.00/hr I S C CONSULTATION FEE _ $78.00/hr SAMPLING INSPECTION FEE n $78.00/hr FOR OFFICE USE ONLY !fiSF!E!i6fl g.!t:RE!3!!PR9P7ln�T�?!?:!!�!�! !?!f!i!f!1!?ri!!Ifi!1!!RR..iM'tII6(S(liitlflll!!(!Ili?tl!!?itl!!!1}fi!ft!itMT.!ii!1!i!!?f!t!ltrhnnm nnrenlfl.A?i!!!!F!!f!fim^:.!t!!?'.!?:T!!S?!!!^i!!?!i!?!!fnn 11.1. MIN II[!p9!^!e'r.!Ilii!lir.:rrcn;rungrttg;tt3i'u!i^ iSiitiillll�plSie!Illf4ipi?!tf!iil!!i?il:fliupli+um;,rg p:�iiai aia r.:rt:niirti iarsn:ni i .nrtmnuun: r.:•enr:::va:r. . 1 ..i.....i....... .... t......_MI I- ... ........ SWEEPS N COMPUTER N LOC CODE DIST CODE AMOUNT RECEIVED CHECK N/CAS" s EH 23 032 (REVISED 6-21-93) Page 11 i $ TOTAL DUE s ,, 00 RECEIVED BY I DATE RECEIVED