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npr 04 02 12s19p Elit Iv Contractors Inc 2094G_1,6342 p.8 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone. (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />FACI6tITY NAME FACILITY CONTACT NAME <br />41 S u .1h /\/� j <br />ouc)(10 S I n t)\ <br />FACILITY ADDRESS SITEPHONE #WIT AREA C E <br />%f / r % <br />t, % 3&Y <br />CITY <br />STATE ZIP CODE -- <br /># OF TANKS AT SITE <br />Liu <br />CA 99 a <br />ZIP CODE <br />APPLICANT QILLING NAME <br />APPLICANT ONTACT NAME <br />I <br />APPLICANTMAILING ADDRESS <br />APPLICANT' # WITH CODE <br />�� <br />f.7`V U <br />PHONE JAREA <br />36 " y <br />CITY STATE <br />ZIP CODE <br />CIRCLE WORK TO BE DONE <br />CONTRACTOR IGC # <br />� s <br />Closure Installation Repair Retrofit <br />AL. If vr- r-'Ruju I T <br />---- <br /># TANKS X $294 = <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK (2002-2007) <br />$550 FEE INCLUDES FACILITY FEE + 1 TANK (2008 & New <br />Installs as of 8/1/07) <br />$125 PER TANK AFTER FIRST TANK <br />2002 <br />2003 <br />2004 <br />2005 <br />2006 <br />2007 <br />$ <br />TANK PENALTY ASSESSED <br />TANK SURCHARGE = $15 / TANK <br />$ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$24.00/ FACILITY <br />$ <br />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # (s): CLOSURE FEE= $294 /TANK <br /># TANKS X $294 = <br />TEMPORARY CLOSURE <br />Plan Review and inspections) <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = $294 / FACILITY <br />I TANK ID # (s) : , PLAN CHECK FEE = $784 / FACILITY I ZI) <br />REPAIR PLAN CHECK <br />TANK ID # s : <br />$ <br />TANK RETROFIT REPAIR FEE = $294 / FACILITY use for monitoring equipment, spill buckets, tank sumps, misc.) <br />$ j <br />PIPING REPAIR FEE = $2941 FACILITY use for piping, under -dispenser containment, ect. <br />$ <br />MISCELLANEOUS <br />- - _...__ <br />TRANSFER FEE _ $ 20 <br />$ <br />CONSULTATION FEE _ $ 98/ HOUR <br />$ <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 98 / HOUR <br />$ <br />SAMPLING INSPECTION FEE = $ 98/ HOUR <br />ALL FEES ARE BASED ON THE $98 HOURLY RATE_ Timt THAT EXCECnc a=re o.r'... .._ ..._ <br />!HAT <br />$ <br />�.__.-..-.. tiry r �vr✓ rv�a-L oc OBLLGV I V Af <br />OFFICE USE ONLY <br />