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SANUIN COUNTY ENVIRONMENTAL HEALTH DTMENT <br />UNDERGROD STORAGE TANK PROGRAM FEE WORKSHEET <br />-12 <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />ELITE IV CONTRACTORS, INC. <br />rird _ <br />5 ORA <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />• <br />(209) 461-6337 <br />CITY <br />STATE <br />ZIP CODE <br />CIRCLE WORK TO BE DONE: <br />Closure Installation Repair Retrofit <br />STOCKTON <br />CA <br />95205 <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />ELITE IV CONTRACTORS, INC. <br />CARRIE MILLER <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />2535 WIGWAM DRIVE <br />(209) 461-6337 <br />CITY <br />STATE <br />ZIP CODE <br />CIRCLE WORK TO BE DONE: <br />Closure Installation Repair Retrofit <br />STOCKTON <br />CA <br />95205 <br />i 1 1998 1999. 1g2000 2001 2002 2003 <br />I $500 1- t=E 1NCL%.tJcS FACILITY FEE +1 TANK - L ($170) x'Vtanks) ($;'.) x (#tanks) <br />PER TANK AFTER FIRST TANK I I I <br />TANK, IENALTY ASSESSED <br />SURCHARGE _ $10 J TANK <br />_ 1 7E iURCHARGE FOR FACILITIES NOT ALFFADY ON INVEM ORY IN A t 'UPA "ROGRAM =$17 <br />r :+'!ANENTC r CRE — <br />` ir2a .1ava1 or Perr itted Closure in Place) <br />TANK ID #(s):C_l_OSU3E FEE =.:279 /'TANK # TAN! -,S. X 4279 <br />—. -- <br />} %:1 IPOR4RY CLOSURE <br />Review and In :pectons) <br />INSTALLATION PLAN CHECK <br />(Plan Check and Construction Ir <br />TANK ID # (s) : <br />REPAIR PLAN CHECK <br />TEMPORARY CL( <br />PLAN CHECK FEE _ $744 / <br />$ <br />TANK ID 4 (s) : <br />TANK RETROFIT REPAIR FEE = $279 / FACILITY (use lo; m2nit2rng equipment, spill buckets, tank sumps, ;nisc.) <br />WIPING REPAIR FEE = $279 ; FACILITY (use for i "ping; under -dispenser containment, ecQ_— <br />Tf'.Ai4*;FER F E =: 'T'20 <br />CONSULTATION FEE _ $ 93/ HOUR <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR <br />SAMPLING INSPECTION FEE _ $ 931 HOUR <br />ALL FEES ARE BASED ON THE $93 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE Bi <br />,OFFICE USE ONLY <br />aERVICE REQUEST # FACILITY ID AMOUNT RECEIVED • CHECK # <br />SR <br />EH 23 032 (REVISED 8101103) <br />.ED TO APPLICANT_ <br />