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SAAOUIN COUNTY ENVIRONMENTAL HEALTH DRTMENT <br />UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET 71 <br />FACR.ITY NAME - <br />FACILITY CONTACT NAME - <br />'APPLICANT CONTACT NAME <br />ELITE IV CONTRACTORS, INC_ <br />FACI(JTY ADDRESS . <br />SITEPHONEt WITH EA CODE <br />MAILING ADDRESS - <br />CITY' STATE <br />ZIP CODE <br />t OF TANKS AT SITE <br />S�C�. CA <br />- <br />STATE <br />LICANT BRING NAME <br />1998 " <br />'APPLICANT CONTACT NAME <br />ELITE IV CONTRACTORS, INC_ <br />2001.2002 <br />CARRZE MILLER. <br />MAILING ADDRESS - <br />APPLICANT PHONE t WITH AREA CODE <br />FA-PPUCA.Wr <br />535.WIGWAM DRIVE <br />ACTIVE FACKITY <br />(209) 461-6337 <br />- <br />STATE <br />ZIP CODE- <br />...::.. ;_:._.. <br />CIRCLE WORK TO BE DONE:TOCKTON <br />Closure InstaLal on Repan Retrofit <br />CA' <br />95205 <br />PERMANENT CLOSDRE - <br />Rem l ocPemWled Cko a in Place ` <br />W STALLATiON <br />1998 " <br />7999. <br />2D00 <br />2001.2002 <br />TANK ID.t(s): <br />2003 <br />$500 FEE INCLUDES FACILITY FEE+7TANK-(s»Plx(maNc.T <br />ACTIVE FACKITY <br />-. .... <br />_." <br />......... <br />...::.. ;_:._.. <br />I $125 PER TANK AFTER FIRST TANK <br />PERMANENT CLOSDRE - <br />Rem l ocPemWled Cko a in Place ` <br />W STALLATiON <br />1998 " <br />7999. <br />2D00 <br />2001.2002 <br />TANK ID.t(s): <br />2003 <br />$500 FEE INCLUDES FACILITY FEE+7TANK-(s»Plx(maNc.T <br />Isvo)x«y <br />-. .... <br />_." <br />......... <br />...::.. ;_:._.. <br />I $125 PER TANK AFTER FIRST TANK <br />• <br />$ <br />TANK PENALTYASSESSED' <br />. <br />$ <br />TANK SURCHARGE =$10/TAW <br />" <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A COPA PROGRAM=$77.5G/ FACILITY <br />PERMANENT CLOSDRE - <br />Rem l ocPemWled Cko a in Place ` <br />W STALLATiON <br />TANK ID t (s):. - <br />CLOSURE FEE =.$279 hTANK <br />t TANKS X $279= <br />TEMPORARY CLOSURE .. -- <br />(Plan Review and trcspecfions) - <br />TANK ID.t(s): <br />TEMPORARY CLOSURE FEE =$279:/FACILITY <br />:;HECK <br />TANK <br />(Plan Cheri: and Construction Inspect <br />TANK ID .i (s)c <br />REPAIR PLAN CHECK <br />OFFICE USE ONLY - <br />SERVICE REQUEST i FACILITY ID AMOIMT RECOVER CHEO(O ' :. RECEIVED B�", <br />SR <br />0123 032 (REVISED EIOI/03) - <br />I <br />4. <br />TANK IDts): - <br />TANK.RETROFIT REPAIR FEE _ $279 / FACILITY (use for nxnkx 1g equipm L spill buckets. tank wisps, mise) <br />$ <br />PIPWGREPAIR FEE =$279 /FACILITY (use Torpipm wder-Sspen�cnntainnwstect) <br />OFFICE USE ONLY - <br />SERVICE REQUEST i FACILITY ID AMOIMT RECOVER CHEO(O ' :. RECEIVED B�", <br />SR <br />0123 032 (REVISED EIOI/03) - <br />I <br />4. <br />