Laserfiche WebLink
•) SAN j0AOUIN COUNTY EWRONMLNTAL HEALTH DEPARTMENT <br /> ! UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> FAGra-'iY NAME FACILITY CONTACT NAME <br /> Mctn Cc qtL <br /> FACILITY ADDRESS3b _ SITE PHONE S WITH AR CODE a v9 �3 <br /> CITY STATE 23PP CODE 0 OF TANKS AT SITE <br /> �C,Ih 1 G J CA <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> ELITE IV CONTRACTORS, INC- CARRIE MILLER <br /> APPLICANT MAKING ADDRESS APPLICANT PHONE 9 WITH AREA CODE <br /> 2535 .WIGWAM DRIVE <br /> ( 209) ,461-6337 <br /> CITY STATE ZIP CODE CIRCLE WORK TO BE DONE <br /> STOCKTOiv <br /> CA 95205 Closure Installation Repair Retrofit " <br /> ACTIVE FACUTY <br /> 1998 1999- 2000 2001 2002 2003 <br /> 1$500 FEE INCLUDES FACILITY FEE+I TANK - (sno►x(awu� (svolx(=�) - - - - <br /> S125.PER TAMC AFTER FIRST TANK <br /> _TANK PENALTYASSESSED - <br /> TANK SURCHARGE_$101 TAW <br /> STATE SURCHARGE FOR FACIL MES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$17.5Cd FACILITY <br /> ez-EIZMANtENT CLOSURE <br /> emTgI onPermiW-Cknure in Place - <br /> TANK ID It(s): CLOSURE FEE=.$279 YTANK It TANKS X$279= $ <br /> TEMPORARY CLOSURE <br /> (Plan Review and trtspectiom) <br /> TANK ID.#(s), TEWORARY CLOSURE FEF=$2794 FACILITY $ i <br /> f. . WSTALLATION PLAN CHECK <br /> (Plan Check and Caestuction Ln edions). <br /> TANK ID;l(s): PLAN QiECK FEE_$744!FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID J7 s) <br /> TANK.RETROFIT REPAIR FEE =$279/FACILITY (use for rnwAxing equipment.spM buckets.tank sumps,mist) $ <br /> PIPINGREPAIR FEE =$279/FACILITY (use for pi xjwAer-dsper-ci mtakunent ect) $( � <br /> MISCELLANEOUS <br /> ANEOUS i <br /> TRANSFER FEE _ $20 - <br /> "CONSULTATION FEE . _ $93/HOUR <br /> UNAUTHORIZED RELEASE EVALUATION FEE . _ $93!HOUR <br /> SAMPLING 94SPECT ION FEE _ $931 HOUR I <br /> I <br /> ALL FEES-ARE BASED ON THE$93 HOURLY RATE TIME THAT OCCFFDS FEES P)W WILL BE RNIED'TO APPLICANT- <br /> OFFICE USE ONLY <br /> SERVICE REQUESTS FACRITY ID AMOUNT RECENED cw=cK a - RECEIVED BY WE RECENED I <br /> SR <br />