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amok <br />5 CUIN COUNTY PUBLIC HEALTH SERVICES <br />NVIRc.m.m NrAL HEALTH OIVISICN <br />• UNOERGRCUNO STCRAGE TANK ?RCGRAN - FEE '-MMEET <br />FACILITY SITE NAME FACILITY CONTACT NAME <br />C <br />I FACILITY ADORESS I SITE PHCNE : with AREA CCCE {-- <br />L r^f S G <br />I <br />T CITYI STATE' .I? COOE I T of TANKS <br />Y A+ '- "C'��.. a t S t T E <br />A APPLICANT/BILLING NAME APPLICANT CONTACT U4E <br />?Mod ec--T <br />® 5+GGi rr `1'gW. Ll�r1 Cpotw1 <br />I HAILING AOORESS APPLIIC�ANTIp?/H�C4E T WI TN -AREA COCE <br />r C,-YM�... SrAr-r_�zz.'prY?e <br />of APPLICATION <br />CLOSURE, INSTALLATIC.V, etc.jK1 1AXTlC <br />TOTAL <br />ANNUAC.ACM ITY FEE (Prior to January 1, 1991) = S100.00 <br />I I I <br />S <br />TANK FEE = S50.00/TANK <br />(prior to January 1,1991) <br />5170/TANK.) (after January 1, 1991) <br />S <br />Tarxs = <br />(.-IAtipty � z fee for <br />each year applicable) <br />1986 11987 1988 11989 ! 1490 <br />I <br />1991 1592 11993 11994 1995 1996 <br />t U <br />I �I t I <br />S • <br />STATE SURMAGEE = $56.00 each TANK (Due every 5 years) See Catifcrnia H b S Code, Sectien 25237 <br />0 Tart:x 556.00 <br />(enter err �t and year)` <br />1986 ;hrct.gh 1990 <br />1991 through 1996 <br />((, <br />S %f / <br />PS.M..NENTMIRS (Remcvat or Authcri,ed Ctcsure-in-Place) TANK I.O. �'(s) <br />CLOSLRE FEE = $53.00 ,per ;tour (3 hours minims_ -n ;er TANK) TANK(s) X 5159.00 = <br />S <br />I ® TANK(s) X 5159.00 = 5 <br />TEMPCUAY CLOSURE (A one-time permit, for review & inspections � TANK I.O. I'M <br />TEMPORARY CLOSURE FEe = $150.00 each TANK X $150.00 = <br />S <br />PLAN CHECK (Ins;alt. Plan Review S Corstrvcticn Irspectiors) TANK I.O. :(s) <br />PLA.Y CHECK FEE - 553.00 per hour (8 hours minim --a ;er Fac it1ty) 5:24.00 '6iriia'a.-4 LV <br />S . <br />RE?AIR <br />I TANK t.0.:(s) <br />TANK RE?AIR FEE = S53.00 per hoar (3 hours minimsyTANK) <br />I ® TANK(s) X 5159.00 = 5 <br />?I?ING REPAIR REVIEW 3 CCNSTRUCTICH = 553.00 per hour (3 <br />hair zinia m per facility = 5159.00) S <br />CCNSULTATICNS <br />FEE, = S53.CO/hr <br />FIC: USE MY <br />�_..«.«. rw: . wiaw:�.iw�a.a;ti �:�.+e:ti:.»•�::s �.sskoa:��'..�:'.`:aa <br />pcuRT <br />OL <br />ai.:,�.,�c�sas:'a�i�s�sy;»,�.:sxa`�:>:.�x.:::�.:.isw=s,:w::r.�-:-::W:...M,•: <br />nr P g <br />TOTAL -UE S <br />OAS: +ce�E6vEu rc�:tii r m <br />s <br />s <br />== lS aS-ft" As gas Ami AM" lR Asea As M ---" "sa <br />