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4 <br />A1116 <br />SAN IAOUIN COUNTY ENVIRONMENTAL HEALTH DEWTMENT <br />UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br />FACKFFY NAME, <br />APPLICANT CONTACT NAME <br />FACILfTYCPNTACT <br />NAME <br />all <br />APPLICANT PHONE 9 WITH AREA CODE <br />2535.WIGWAM DRIVE: <br />(209)_461-6337 <br />F,CClWY ADD SS <br />STATE <br />SITE PHONE <br /># WITH AREA CODE <br />-STOCKTON <br />CA'- <br />95205 <br />Ab <br />crry�— <br />STATE <br />ZIP CODE <br />OF TANKS AT SITE <br />q <br />" I <br />� <br />CA <br />*' <br />1 <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />ELITE IV CONTRACTORS, INC <br />CARRIE MILLER. <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE 9 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. instaffatim Repir Retrofit <br />-STOCKTON <br />CA'- <br />95205 <br />ACTIVE FACILITY <br />TANK ID 0 (s): CLOSURE FEE =1279 /TANK <br />V TANKS X $279 <br />1998 <br />1999. <br />2000 <br />2001 <br />2002 <br />2003- <br />$500 FEEINCLUDES FACILITY FEE:* I TANK <br />(sm) x mwd,* <br />(si 70)x (atc--) - <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 =$17.5G/ FACILITY. - <br />PERMANENT Cl RE <br />(Removalor. PemittedCbsureinPlace '-- <br />TANK ID 0 (s): CLOSURE FEE =1279 /TANK <br />V TANKS X $279 <br />TEMPORARY CLOSURE <br />(Plan Riaview and kispec ms) <br />TANK ID4(s): <br />TEliPofZARY CLOSURE FEE = $279:1 FACILITY <br />RdSTALLATION PLAN CHECK <br />(plan Check and Corzstructioc+ Inspections) <br />-FEE <br />TANK ID;ff (s): PLAN CHECK .,$7441 FACILITY <br />REPAIR PLAN CHECK <br />MISCELLANEOUS <br />TRANSFER FEE $20 <br />CONSULTATION FEE $ 93/ HOLIR <br />UNAUTHORIZED RELEASE EVALUATION FEE $931HOUR <br />SAMPLING INSPECTION FEE $ 931 HOUR <br />ALL FEES -ARE BASED ON THE $93 HOURLY RATE- TIME THAT EXCEEDS FEES PAID WILL BE BUI-ED TO Al <br />ncrlr_r- IMP nm v <br />TANK ID f; (s): <br />TANK -RETROFIT REPAIR FEE $2791 FACILITY (use for ma*ring equipment spa buckets. Lu* suinps. misc.) <br />PIPINGREPAIR FEE =$2791 FACILITY (use for pWm wideridsperiser oottairwn enL ect.) <br />MISCELLANEOUS <br />TRANSFER FEE $20 <br />CONSULTATION FEE $ 93/ HOLIR <br />UNAUTHORIZED RELEASE EVALUATION FEE $931HOUR <br />SAMPLING INSPECTION FEE $ 931 HOUR <br />ALL FEES -ARE BASED ON THE $93 HOURLY RATE- TIME THAT EXCEEDS FEES PAID WILL BE BUI-ED TO Al <br />ncrlr_r- IMP nm v <br />