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SAN JOAQUIN COUNTY ENWOI3L NTAL HEALTH DEPARTMENT <br />UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br />FAGM it NAME -- <br />FACILITYCONTACTNAME <br />T <br />I► `Ln <br />FACT ADDRESS <br />SITE PHONE 9 WIV AREA CODE <br />253S .WIGWAM DRIVE <br />-� <br />CIN <br />ATE <br />21? CODE <br />S OF TANKS Al SITE <br />.S TOCK TON <br />CA <br />95205 <br />- - <br />BILLING NAME <br />-APPLICANT CONTACT NAME <br />rPPLICANT <br />ELITE IV-CONTRACTORS,'INC- <br />CARRIE-MILLER. <br />PPLICANT MAILING ADDRESS - <br />APPLICANT PHONE 0 WITH AREA CODE <br />253S .WIGWAM DRIVE <br />(209) .461-6337 <br />CIN <br />STATE <br />ZIP CODE <br />CIRCLE WORK TO BE DONE <br />-Ck=ff4dUntalation Repair Retrofit <br />.S TOCK TON <br />t C,A'' <br />95205 <br />ACTNE FAC2ITY - - <br />'-PERKAMENT C1,0WRE <br />1998- <br />1999. <br />2000 <br />2001. <br />2002 <br />2003 <br />$500FEE.INCLUDESFACIL"FEE+-1TANIG- <br />(st7o)x(mw*4 <br />(s170).x(-64 <br />-CONSULTATION FIS : = S 931 HOUR <br />- <br />- <br />- - <br />( 5125.PER*ANKAFTERFIRSTTANK <br />UNAUTHORIZED RELEASE EVALUATK)M FEE = S 93 I HOUR . <br />SAM <br />$ <br />PL04G INSPECTION Fig✓ _ $ 931 HOUR <br />. <br />TANK PENALTYASSESSED - <br />_ <br />$ <br />TANK SURCHARGE = $101 TANK <br />STATE SURCHARGE FOR FACti_tTIES NOT ALREADY ON I14MORY IN A CUPA PROGRAM=517.5G/ FACHM : <br />'-PERKAMENT C1,0WRE <br />TANK ID Jl ls) = . CLOSURE FEE =5279 rTANK <br />S TANKS X $279= <br />TE>idPORARY CLOSURE <br />(Plan Review and kmpec5ons) <br />TAMC ID.# (s).: <br />TEMPORARY CLOSURE FEE= $279J FACILITY . <br />INSTALLAMM PLAN -CHECK <br />(Plan Check and Construc6m lns<,euions) . <br />TANK ID tY s) <br />$ <br />TAtafIZ ID ;7 (s): <br />PLAN CHECK FEE =.$7.441 FACIUTY '. <br />REPAIR PLAN CHECK <br />TANK ID tY s) <br />REPAIR FEE _ $2791 FACiUTY (crime for ffv*nng equipment spM bvdkets. tank sumps, mist)IIJGREPAIR <br />$ <br />�TAWNKRETROFIT <br />FEE -= $2791 FACILITY (cse forpWng:-ides is -cors -M—t ect) <br />3tEtSCELLAAtEOtis <br />$ <br />TRANSFER FIS = S'20 <br />-CONSULTATION FIS : = S 931 HOUR <br />UNAUTHORIZED RELEASE EVALUATK)M FEE = S 93 I HOUR . <br />SAM <br />$ <br />PL04G INSPECTION Fig✓ _ $ 931 HOUR <br />. <br />.s <br />. i <br />_ t <br />ALL FEES ARE BASED ON THE $93 HOURLY RATE_ WE THAT EXCELS FEES PAID W LL BE BALED -TO APPLICANT- <br />OEFICE USE ONLY <br />SERVICE f. EQUEST S FACA M K3 AMOUNT RECEIVED -' CHECK 9 ` : - � RY O&TE RSIAE.D . t <br />SR- L <br />-.. <br />