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SANJUAQUIN LOCAL, RICT <br />ERGROUFJ-STG��,� <br />i? <br />FACKITY/SITE NAME <br />,-- <br />FACILITY CONTACT <br />--NAME <br />C <br />T <br />1 <br />® v <br />( <br />1987 <br />,fes,. <br />l• G! �� <br />L <br />T <br />STREET ADDRESS <br />S TE PHONE $ (with Area Code) <br />Y <br />CITY . <br />STS <br />ZIP CODE <br />512.(11 <br />$ of TANK'S <br />at Site <br />A <br />P <br />APPLICANT/BILLING NAME <br />APPLICANT CONTACT NAME <br />P <br />1986 <br />1987 <br />L <br />1989 <br />II <br />MAILING ADDRESS <br />/a <br />APPLICANT PHONE t (with Area Code) <br />A <br />✓ <br />�, <br />N <br />T <br />CITY <br />�dl�/K1 <br />SITLZIPCODE <br />TYPE of APPLICATION <br />(Closure, Installation, etc.) <br />A <br />FACILITY FEE = $100.00 each SITE ADDRESS per YEAR <br />TOTAL <br />C <br />T <br />1 <br />t Tanks x $90.00 $ <br />----- <br />1986 <br />1987 <br />1988 <br />1989 <br />TEMPORARY CLOSURE FEE = $80.00 each TANK <br />t Tanks x $80.00 6 <br />60 <br />E <br />TANK FEE = $50.00 each TANK <br />F <br />A <br />C each <br />t Tanks x $50.00 <br />(oultipIy -by fee for <br />year applicable) <br />1986 <br />1987 <br />1988 <br />1989 <br />✓ <br />; .mob �! <br />I <br />STATE SURCHARGE = $56.00 each TANK (see CA HEALTH k SAFETY CODE Sec 25287 for applicability) <br />T <br />Y <br />I Tanks�__ x $56.00 <br />(enter imount and year) <br />1986 <br />1987 <br />1988 <br />1989 <br />C <br />L <br />PERMANENT CLOSURE (Removal or Closure -in-place) <br />S <br />CLOSURE FEE = $90.00 each TANK <br />t Tanks x $90.00 $ <br />----- <br />U <br />R <br />E <br />TEMPORARY CLOSURE (Only allowed one time for up to two years) <br />TEMPORARY CLOSURE FEE = $80.00 each TANK <br />t Tanks x $80.00 6 <br />PLAN CHECK (Installation or Repair) <br />i -- <br />I PLAN CHECK FEE = $30.00 each SUDMISSION/RESUBMISSION Fs <br />.30 0-0 <br />E TANK REPAIR FEE 2 $110.00 each TANK 1 Tanks x $110.00 $ <br />P <br />I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br />R <br />UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION SAMPLING <br />(when applicable) INSPECTION INSPECTION <br />FEE = $30.00/hr FEE = $35.00/hr FEE = $35.00/hr $ <br />TOTAL DUE f f l- 0 <br />OFFICE USE ONLY <br />