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r0-26-201 6:18AM FR ACRAMENTO EMC 9169252816 P.5 <br />&ART.Itlul(2 OUNTY.PUBXACHEALTHSMVICES-ENVIRONMZNTAL 0r'w0N <br />UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br />FAC11,1TY W*Z <br />FA=TTY CONTACT NAW <br />More for Lens 97 <br />TANK PENALTY ASSESSED <br />Utilmawn <br />FAClLffY AUI.)kFSS <br />SITE PHONE N WrM AREA CODE <br />$ <br />3 Won Cnntiine pwud <br />$ <br />209 R35 961A <br />CITY <br />STATE <br />ZIP u OF TANKS (0 sn7, <br />CLOSURE FEE - $ 263 / TANK <br />h TANKS x $ 261 - <br />C�iforn6a <br />976 3 <br />APPLICANT BILLING NAME <br />APPXJ,CANP CONTACT NAME <br />TEMPORARY CLOSURE FEE _ $a61 / FACILITY <br />In��ncnto Equipment Ma6nk=uce. Company, Inc, <br />INSTALLATION PLAN CHECK <br />Linda St xer <br />(Plan ehftk and ConstrucWn Dtspections) <br />APPLICANT MAILWG ADI)khss <br />TANK 10 (s): PLAN CHECK IEE = $6% / FACILITY <br />APPLICANT PRON8 iI WITH AREA CCmL• <br />24W Connie Dtive <br />TANK ID # (s): <br />CITY <br />STATE <br />ZIP CIRCLE WORK •rO BE DONE. <br />Sscramenlo <br />CaTlfonda <br />9S8i5 <br />' <br />S 261.00 <br />Clpenre Instellati R.ePair iLofit <br />ACTTVk FACILITY <br />$ 500 FEE INCLUDES FACIT [TY VFF + I TANK <br />I m - I?. <br />200x1 2001 <br />$125 PER TANK .AFTER FIRST TANK . <br />($170) x (# Lab) x (# of <br />ye ax applicable) <br />TRANSFER FEE _ $ 20 $ <br />CONSULTATION FEE =, $ 871 HOUR $ <br />UNAUTHORIZED RELEASE EVALUATION FEE _ $ 87./ HOUR $ <br />SAMPLING INSPECTION PEE = $ 87 / HOUR $ , <br />ALL FEES ARE BASED ON THE $ 87 HOURLY RATE TIME THAT FxcF d6 FEES PAm Wri r RF Rn r Fn Tn Acw me = <br />Vrraur. Y7G WMLv <br />SERVJ; I RPCUEBi # __ FAQURY ID _ _ _LmeCEMD� t•ncrvr v <br />SR <br />V: \ wamv \ San Joagatn \ cov \ forms \ oertnits \ N"ir%4 Wo #106705 <br />$ <br />TANK PENALTY ASSESSED <br />TANK SURCHARG13-3 8/TANK <br />$ <br />STATE S'LIRCHARGE FOR FACfLYf11iS NOT ALREADY UNINVENTORY IN A CUPA PROGRAM - $ I0 / FAC=Y <br />$ <br />PMMANM CLOSURE <br />(Rnwval of Pe ittod Closure in An w) <br />TANK iD d (S): <br />CLOSURE FEE - $ 263 / TANK <br />h TANKS x $ 261 - <br />S <br />TFAeORARY CLOSURE <br />(Plan Review and. tnapoctisxz) <br />TANK ID $ (S): <br />TEMPORARY CLOSURE FEE _ $a61 / FACILITY <br />; <br />INSTALLATION PLAN CHECK <br />(Plan ehftk and ConstrucWn Dtspections) <br />TANK 10 (s): PLAN CHECK IEE = $6% / FACILITY <br />REPAxR1PLAN CNECK <br />TANK ID # (s): <br />TANK LINING REPAIR FFA _ $ 261 / TANK <br /># TANKS x $261 = <br />$ <br />TANK RETROFIT REPAIR FEE = $ 261 / FACILITY <br />$ <br />PIPING REPAIR FEE _ $,x61 / FAc31m <br />-- - <br />S 261.00 <br />TRANSFER FEE _ $ 20 $ <br />CONSULTATION FEE =, $ 871 HOUR $ <br />UNAUTHORIZED RELEASE EVALUATION FEE _ $ 87./ HOUR $ <br />SAMPLING INSPECTION PEE = $ 87 / HOUR $ , <br />ALL FEES ARE BASED ON THE $ 87 HOURLY RATE TIME THAT FxcF d6 FEES PAm Wri r RF Rn r Fn Tn Acw me = <br />Vrraur. Y7G WMLv <br />SERVJ; I RPCUEBi # __ FAQURY ID _ _ _LmeCEMD� t•ncrvr v <br />SR <br />V: \ wamv \ San Joagatn \ cov \ forms \ oertnits \ N"ir%4 Wo #106705 <br />