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LLtJNtY PUBLIC HEALTH SERVICES - ENVIRON?dENTAI HEALTH DIVSIQM <br />ET <br />UNDERGROUND STORAGE TANK PROGRAM - FEE TALKSHHE <br />• S FACILITY SITE NAME <br />7 Ij�v r. FA . a TY CONTACT NAME <br />\ <br />` 'tet _ <br />E FACILITY ADDRESS I. - << .,' ,1 _ <br />_ �i <br />& ; ,`f. ,r SITE PHONE # With AREA CODE <br />CITY � �� %l ��r <br />A j STATE ZIP CODE # of TANKS <br />P =1r ! ,q� at SITE <br />P APPLICANT/BILLING NAME <br />L <br />I 1': ) APPLICANT CONTACT NAME <br />CI MAILING ADDRESS <br />A A. APPLICANT PHONE # WITH AREA CODE <br />T CITY <br />STATE ZIP CODE TYPE of APPLICATION <br />(:t'•, _°; (Closure, Installation, etc.) <br />TOTAL <br />I ! ANNUAL FACILITY FEE (Prior to January 1, 19^91 <br />A) ) = 510 00 ! 19c''6 11987 1 1988 1989 1990 <br />Cl <br />T1 FACILITY PENALTY FEES ASSESSED (If Applicable) Y <br />II xXKx xxxx <br />VI TANK FEE $50.00/TANK$ <br />Ei (Prior to January 1,1991) <br />5170/TANK (After January 1, 1991 <br />Tanks = � ) <br />FI (multiPty 1986 1987 11988 1:89 1990 190t ; 1992 11993 11994 <br />P Y � by fee for 11995 1 <br />A! each year applicable) 1996 <br />C' i <br />I TANK PENALTY FEES ASSESSED <br />L ' xxx XXxx <br />f I I ! I <br />II STATE SURCHARGE' = 556.00 each TANK 5 <br />T (Cut evcry 5 years) 5,•,•1. <br />Ca tfornia v S Code, Section 25287 <br />Y� - anis x $56.00 <br />(Enter amount and I dab thrcu�t 1000 <br />year) ( 1::1 through 1996 <br />i ---- — <br />$ <br />CI RHANEP)[ CLOSURE (Removal or <br />L Au[h�ri_•r Cirsurc-in <br />F i.1Cn) <br />LE. <br />:CSURE FEE - S78.00/'tour (j hr� n: -- — --- - --- — <br />_ �.tn; -ARA) —_ <br />^.0 I a TANK(,)— <br />P „PY Cl.OS RE (clan Re w y �O = 3 <br />� vie ^c;ection" <br />"�CRAR" CLI -'SURE FEE = 578.00„ -- -----' ra+.[ J.D. a(s) <br /># T <br />ANK(s) ( 5234.00 = $ <br />PINSTALLATICN PLAN CHECK (Plan Review s C..nstrurti�n in <br />L1 <br />Al pectiors)i SANK (.p-(;) <br />NI PLAN CHECK FEE = S78.00/hour (8 hours minimunlFACILITY) _ <br />- 5624.00 minirx-m <br />$ <br />Rl REPAiR FEE (»'crk tan Review evicu 8 Ccr,S[ru <br />Ei :i <br />on Ins c tions) <br />P ^iK .1N1 7AYK <br />* "„ ;EPA FEE = S7 ^ <br />A, 8.x:1/in (3 -:.rs------- <br />'AtiK(s) x 57-34.00 = $ <br />(i TANK RETRCFIT REPAIR FEE = $78.0 <br />RI (3 hers min./FACILITY) �i— <br />R ) $234.00 miniaK--j <br />PIPING REPAIR FEE = $78.00/hour (3 hours minimum/FACILITY) $ <br />_ $234.00 minimum ,. <br />HI TRANSFER FEE _ $20.00 <br />I <br />S' <br />Cl CONSULTATION FEE = 578.00/hr <br />UNAUTHORIZED RELEASE EVALUATION = $78.00/hr <br />