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SAN JIMUIN COUNTY ENVIRONMENTAL HEALTH DTMENT UNDERGRO D STORAGE TANK PROGRAM F WORKSHEET +r I!II APPLICANT BILL G NAME APPLICANT CONTACT NAME ELITE IV CONTRACTORS, INC. CARRIE MILLER APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE 2535 WIGWAM DRIVE (209) 461-6337 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE: STOCKTON CA 952 0 5 Closure Installation Repair Retrofit ACTIVE FACILITY 1998 1999 2000 2001 2002 2003 $500 FEE INCLUDES FACILITY FEE + -1 TANK- ($»o) x (hanks) ($170) X (ftnks) I $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 IRemoval or Pemlitted Closure in PlaceANK ID # (s) : CLOSURE FEE = $279 / TANK # TANKS X $279 = TEMPORARY CLOSURE (Plan Review and Inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $279 / FACILITY IN5IALLATION PLAN CHECK Plan Check and Construction Ins TANK ID # (s) : actions) PLAN CHECK FEE = $744 / FACILITY REPAIR PLAN CHECK TANK ID # (s): TANK RETROFIT REPAIR FEE = $279 /FACILITY (use for monitoring equipment, spill buckets, tank sumps, misc.) $ PIPING REPAIR FEE = $279 / FACILITY (use for piping, under -dispenser containment, ect) ALL FEF ARE BASED APPLICANT BILL G NAME APPLICANT CONTACT NAME ELITE IV CONTRACTORS, INC. CARRIE MILLER APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE 2535 WIGWAM DRIVE (209) 461-6337 CITY STATE ZIP CODE CIRCLE WORK TO BE DONE: STOCKTON CA 952 0 5 Closure Installation Repair Retrofit ACTIVE FACILITY 1998 1999 2000 2001 2002 2003 $500 FEE INCLUDES FACILITY FEE + -1 TANK- ($»o) x (hanks) ($170) X (ftnks) I $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 IRemoval or Pemlitted Closure in PlaceANK ID # (s) : CLOSURE FEE = $279 / TANK # TANKS X $279 = TEMPORARY CLOSURE (Plan Review and Inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $279 / FACILITY IN5IALLATION PLAN CHECK Plan Check and Construction Ins TANK ID # (s) : actions) PLAN CHECK FEE = $744 / FACILITY REPAIR PLAN CHECK TANK ID # (s): TANK RETROFIT REPAIR FEE = $279 /FACILITY (use for monitoring equipment, spill buckets, tank sumps, misc.) $ PIPING REPAIR FEE = $279 / FACILITY (use for piping, under -dispenser containment, ect) ALL FEF ARE BASED ACTIVE FACILITY 1998 1999 2000 2001 2002 2003 $500 FEE INCLUDES FACILITY FEE + -1 TANK- ($»o) x (hanks) ($170) X (ftnks) I $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 IRemoval or Pemlitted Closure in PlaceANK ID # (s) : CLOSURE FEE = $279 / TANK # TANKS X $279 = TEMPORARY CLOSURE (Plan Review and Inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $279 / FACILITY IN5IALLATION PLAN CHECK Plan Check and Construction Ins TANK ID # (s) : actions) PLAN CHECK FEE = $744 / FACILITY REPAIR PLAN CHECK TANK ID # (s): TANK RETROFIT REPAIR FEE = $279 /FACILITY (use for monitoring equipment, spill buckets, tank sumps, misc.) $ PIPING REPAIR FEE = $279 / FACILITY (use for piping, under -dispenser containment, ect) ALL FEF ARE BASED PERMANENT CLOSURE IRemoval or Pemlitted Closure in PlaceANK ID # (s) : CLOSURE FEE = $279 / TANK # TANKS X $279 = TEMPORARY CLOSURE (Plan Review and Inspections) TANK ID # (s) : TEMPORARY CLOSURE FEE = $279 / FACILITY IN5IALLATION PLAN CHECK Plan Check and Construction Ins TANK ID # (s) : actions) PLAN CHECK FEE = $744 / FACILITY REPAIR PLAN CHECK TANK ID # (s): TANK RETROFIT REPAIR FEE = $279 /FACILITY (use for monitoring equipment, spill buckets, tank sumps, misc.) $ PIPING REPAIR FEE = $279 / FACILITY (use for piping, under -dispenser containment, ect) IN5IALLATION PLAN CHECK Plan Check and Construction Ins TANK ID # (s) : actions) PLAN CHECK FEE = $744 / FACILITY REPAIR PLAN CHECK TANK ID # (s): TANK RETROFIT REPAIR FEE = $279 /FACILITY (use for monitoring equipment, spill buckets, tank sumps, misc.) $ 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 _ $ 93/ HOUR $ OFFICE USE ONLY ALL FEF ARE BASED OFFICE USE ONLY