Laserfiche WebLink
SAN ASPUIN COUNTY ENVIRONMENTAL HEALTH DAWRTMENT <br />UNDERGRMND STORAGE TANK PROGRAM FWWORKSHEET <br />FACJkLtTY NAME <br />FACILITY CONTACT NAME <br />ELITE IV CONTRACTORS, INC. <br />CARRIE MILLER <br />APPLICANT MAILING ADDRESS <br />FACIL ADDR S <br />SITE PHONE # WITH AREA CODE <br />(209) 461-6337 <br />CITY <br />STATE <br />CITY <br />STATE <br />ZIP CODE <br /># OF TANKS AT SITE <br />Llih ILL� <br />I CA <br />L y s <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 />ACTIVE FACILITY <br />TANK ID # (s) : <br />CLOSURE FEE= $279 /TANK # 1 ANKS X $279 = <br />1998 <br />1999 <br />2000 <br />12001 <br />2002 <br />2003 <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK <br />($170) x (#tanks) <br />($170) x (manks) <br />$125 PER TANK AFTER FIRST TANK <br />TANK PENALTY ASSESSED <br />TANK SURCHARGE = $10 / TANK <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$17.50/ FACILITY <br />PERM ENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # (s) : <br />CLOSURE FEE= $279 /TANK # 1 ANKS X $279 = <br />TEMPORARY CLOSURE <br />(Plan Review and Inspections) <br />TANK ID # (s):, <br />I TEMPORARY CLOSURE FEE = $279 ! FACILITY <br />INSTALLATION PLAN CHECK <br />(Plan Check and Construction Inspections) <br />TANK ID # (s) : <br />I PLAN CHECK FEE = $744 / FACILITY <br />REPAIR PLAN CHECK <br />TANK ED# s): <br />TANK RETROFIT REPAIR FEE = $279 / FACILITY (use for monitoring equipment, spill buckets, tank sumps, misc.l <br />PIPING REPAIR FEE = $279 / FACILITY (use for piping, under -dispenser containment, ect) <br />MISCELLANEOUS. <br />CONSULTATION FEE _ $ 93/ HOUR <br />UNAUTHORIZED RELEASE EVALUATION FEE _ $ 93 ! HOUR <br />SAMPLING INSPECTION FEE _ $ 93/ HOUR <br />ALL ttCJ AKt MAZr-U UJM Inr 4WJ MUUKLT KAI r. IIMM 1MAI r-AC,=UZI rCCJ rA[U WILL t5M tslLLrI• IV ArrU%,f Mi. . <br />OFFICE USE ONLY <br />SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br />SR <br />EH 23 032 (REVISED 8/01/031 <br />