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naS eu U4 Utl: 1Ga s.arrse Drawn <br /> ' SANOQUIN COUNTY ENVIRONMENTAL HEALTH DEFWENT <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> FACT MNAME FACN.fT`L CONTACT NAME <br /> FAChSTY ADDRESS O` I S�ONE#WITH 4REA GODS <br /> CITY STATE 21P CODE <br /> k Of TANKS AT SITE <br /> S�0cY,\kc, CA <br /> gPPUCANT WILLING NAME APPLICANT OONTACT NAME <br /> ELITE IV CONTRACTORS, INC. CARRIE MILLER <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 2535 WIGWAM DRIVE 209 461-6337 <br /> CITY STATE. ZAP CODE CIRCLE WORK TO BE DONE <br /> STOCKTON CA I 95205 Gosure ussEWslion Repair Retrofit <br /> AC7)vE FACIUTY <br /> 1998 20 <br /> 1999 00 2001 2002 2003 <br /> 1 $500,FEE INCLUDES FACILITY FEE-1 TANK fsnUlX llnantcJ ISVDIX(Ranla) - <br /> E125 PER TANK AFTER FIRST TANK $ <br /> _TANK PENALTY ASSESSED $ <br /> TANK SURCHARGE=510/TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENiOP.Y IN A CUPA PROGRAM=E17.5�'FACWTY <br /> PERMANENTCLOSURE <br /> Removal or PermlOad Closure In Place <br /> $ <br /> TANK ID#(s) I CLOSURE FEE=52791 TANM It TANKS X$279= <br /> TEMPORARY CLOSURE <br /> Plan Review and lnspa U=I <br /> TANK ID#(s): TEMPORARY CLOSURE FEE a$2791 FACILITY <br /> INS ALLATION PLAN CHEC <br /> Plan <br /> 12L"d Construction inspections) <br /> TANK 10 It IS)' 1 PLAN CHECK FEE=$7441 FACILITY <br /> AIR PLAN CHECK <br /> TANK ID# s) <br /> TANK RE 11(3) REPAIR FEE -5279!FACILITY (•v'e for moniLmng equipment.spill buckets,tank sumps,misc.) <br /> -- —' $ <br /> PIPING REPAIR FEE .$279 f FACILITY (use for p1pilig.under-disDensw=Iteinnsan,eCt <br /> MISCELLANEOUS <br /> TRANSFER FEE = $20 <br /> _ _ ----- — Is <br /> CONSULTATION FEE = 5931 HOUR $ <br /> i <br /> UNAUTHORIZED RELEASE EVALUATION PEE_- li S3 I HOUR $ f <br /> i <br /> SAMPLING INSPECTION FEE = E 93/HOUR <br /> ALL FEES ARE BASED ON THE 581 HOURLY RATE• TIME THAT EXCEED5 FEES PAID WILL BE BILLED TO APPLICANT. j <br /> OFFICE USE ONLY {• <br /> SERVICE ICEOUESTi FACILITY ID AMOUNT RECIIJED CHECK T RECEIVED BY I DATE RECEIVED .l <br /> i <br /> SR <br /> EH 23 D32(RiMSED l A3L <br />