COMPLIANCE INFO_1985-2005 - Laserfiche WebLink

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SAN JOAMUIN COUNTY ENVIRONMENTAL HEALTH DE' TMENT UNDERGRO, STORAGE TANK PROGRAM F ORKSHEET FACILITY NAME FACILITY CONTACT NAME S V A S 7— 9m, m ts A 0l r a. SITE PHONE # WITH AREA CODE FACILITY ADDRESS 7- 20q T3-5--f38-f CITYSTATE CITY ZIP COD,.E^* —T—# OF TANKS AT SITE -7—r aC. G CA .7 V7 67-W O •2 APPLICANT BILLING NAME APPLICANT CONTACT NAME ELITE IV CONTRACTORS, INC. 1998 APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE 2535 WIGWAM DRIVE (209) 461-6337 CITY I STATE ZIP CODE CIRCLE WORK TO BE DONE: 95205 Closure Installation Repair Retrofit S TOCKTON -T CA ACTIVE FACILITY TANK ID # (s) : 1998 1999 2000 2001 2002 2003 $500 FEE INCLUDES FACILITY FEE + 1 TANK ($170) x (hanks) ($170) x (Ranks) _� $ SAMPLING INSPECTION FEE _ $ 931 HOUR $125 PER TANK AFTER FIRST TANK $ $ TANK PENALTY ASSESSED $ TANK SURCHARGE = $10 / TANK $ STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$17.50/ FACILITY PERMANENT CLOSURE Removal or Permitted -Closure in Pla TANK ID # (s) : CLOSURE FEE = $279 /TANK # TAN'{S Y $279 _ _ --- — TEMPORARY CLOSURE (Plan Review and Inspections) _ ��` TANK ID # (s) :. _ TEMPORARY CLOSURE FEE _ $279 I' FACILITY --__1 (Plan Check and Construction Inspections) TANK D # (s) : -- T—PLAN CHECK FEE = $744 / FACILITY _ `i — 1 REPAIR PLAN CHECK TANK ID # (s) : TANK RETROFIT REPAIR FEE = $279 / FACILIT_Y (use for monitoring equipment, spill buckets, tank sumps, misc.) $� 77. . PIPING REPAIR FEE =$279/FACILITY (use for piping, under -dispenser containment, ect.) $ MISCELLANEOUS TRANSFER FEE _ $ 20 $ CONSULTATION FEE _ $ 93/ HOUR $ UNAUTHORIZED RELEASE EVALUATION FEE _ $ 93 ! HOUR _� $ SAMPLING INSPECTION FEE _ $ 931 HOUR OFFICE USE ONLY SERVICE i2EQUEST # FACIU1 SR EH 23 032 (REVISED 8101/03) ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED